# FAMILY MEDICINE OF HARRELLSVILLE

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

## Provider details

- **NPI number:** 1124003934
- **Authorized official:** DR. GADDY MATHESON LASSITER M.D. (CEO)
- **Authorized official phone:** (252) 356-6544

## Contact information

- **Practice address:** 103 E MAIN ST, HARRELLSVILLE, NC 27942-9201
- **Practice address phone:** (252) 356-6544
- **Practice address fax:** (252) 356-9907
- **Mailing address:** 103 E MAIN ST, HARRELLSVILLE, NC 27942-9201
- **Mailing address phone:** (252) 356-6544
- **Mailing address fax:** (252) 356-9907

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NC | Yes |

## Other

- **Enumeration date:** 12/14/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1216W | BC/BS INDIVIDUAL \# | NC |
| 05 | — | 891216W | — | NC |