# LAKE NORMAN SURGICAL ASSISTING

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

## Provider details

- **NPI number:** 1093005878
- **Authorized official:** CHARLES ANTHONY TUDOR PA-C (MANAGING PARTNER)
- **Authorized official phone:** (704) 663-4989

## Contact information

- **Practice address:** 1130 GRACE MEADOW DR, MOORESVILLE, NC 28115-2789
- **Practice address phone:** (704) 663-4989
- **Mailing address:** 1130 GRACE MEADOW DR, MOORESVILLE, NC 28115-2789
- **Mailing address phone:** (704) 663-4989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 101593 | NC | Yes |

## Other

- **Enumeration date:** 04/13/2011
- **Last updated:** 04/01/2014