MEDICARE: PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1972279388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 GREEN MEADOW DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-7406
Country	:	US
Telephone Number	:	704-586-8292
Fax Number	:	704-865-1158

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JON LEIZMAN
Credential	:	MD
Telephone Number	:	216-479-9063

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/24/2022

Similar Medicare Providers

1194438432 — MRS. MORGAN SHORT HOWARD FNP-C
Practice Location Address:

2605 GREEN MEADOW DR
GASTONIA, NC
28052-7406

Practice Phone: 877-685-5886
Practice Fax:

1417816281 — GRACE RITCHEY
Practice Location Address:

1601 MADISON ST
GASTONIA, NC
28052-0846

Practice Phone: 704-866-6094
Practice Fax:

1184439895 — SANNI ENTERPRISE LLC
Practice Location Address:

1312 LINEBERGER AVE
GASTONIA, NC
28052-0717

Practice Phone: 980-248-9079
Practice Fax:

1548389125 — GASTON FAMILY HEALTH SERVICES, INC.
Practice Location Address:

111 E 3RD AVE
GASTONIA, NC
28052-4343

Practice Phone: 704-874-3300
Practice Fax: 704-874-0065

1518825983 — EQUALIFE HEALTH & WELLNESS
Practice Location Address:

318 S SOUTH ST STE 6B
GASTONIA, NC
28052-4379

Practice Phone: 630-930-2975
Practice Fax:

1346030525 — GASTON FAMILY HEALTH SERVICES INC
Practice Location Address:

1601 MADISON ST
GASTONIA, NC
28052-0846

Practice Phone: 704-866-6094
Practice Fax: 704-866-6311

Directions to “PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.