# EMERGENT LIFE INTEGRATIVE MEDICINE CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053953125
- **Authorized official:** BARANY JEGANATTH (FOUNDER, GENERAL MANAGER)
- **Authorized official phone:** (919) 961-2204

## Contact information

- **Practice address:** 5104 REAGAN DRIVE, SUITE 4, CHARLOTTE, NC 28206-1392
- **Practice address phone:** (919) 961-2204
- **Mailing address:** 5104 REAGAN DRIVE, SUITE 4, CHARLOTTE, NC 28206-1392
- **Mailing address phone:** (919) 961-2204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204R00000X | Electrodiagnostic Medicine Physician | — | NULL | — |
| 204R00000X | Electrodiagnostic Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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