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General NPI Number Information
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NPI Number | 1942255708
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Entity Type | Organization
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Legal Business Name | STANLY FAMILY CARE CLINIC PA
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 1007 N 6TH ST
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City | ALBEMARLE
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State | NC
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Zip | 28001-3551
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Country | US
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Telephone | 704-983-3121
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Fax | 704-983-4659
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Provider Business Mailing Address
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Address Line | 1007 N 6TH ST
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City | ALBEMARLE
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State | NC
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Zip | 28001-3551
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Country | US
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Telephone | 704-983-3121
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Fax | 704-983-4659
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC MERRIMAN JOHNSEN
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Credential | M.D.
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Telephone | 704-983-3121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24425
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License Number State | NC
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