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General NPI Number Information
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NPI Number | 1407058555
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Entity Type | Organization
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Legal Business Name | NORTH MECKLENBURG PLASTIC SURGERY
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 403 GILEAD RD SUITE B
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-6813
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Country | US
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Telephone | 704-947-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 13729 BRAMBOROUGH RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3719
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Country | US
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Telephone | 704-947-8877
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | SHERI NOWICKY
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Credential |
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Telephone | 704-947-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 200201133
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License Number State | NC
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