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Organization
EMERGENT LIFE INTEGRATIVE MEDICINE CENTER, INC
Active
Organization
EMERGENT LIFE INTEGRATIVE MEDICINE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARANY JEGANATTH (FOUNDER, GENERAL MANAGER)
(919) 961-2204
Entity
Organization
Contact information
Practice address
5104 REAGAN DRIVE, SUITE 4, CHARLOTTE, NC 28206-1392
(919) 961-2204
Mailing address
5104 REAGAN DRIVE, SUITE 4, CHARLOTTE, NC 28206-1392
(919) 961-2204
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
NULL
204R00000X
Electrodiagnostic Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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