# IREDELL PHYSICIAN NETWORK LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Iredell Ear, Nose and Throat
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447063920
- **Authorized official:** CARLA D JOHNSON (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (980) 434-3803

## Contact information

- **Practice address:** 740 BRYANT ST, STATESVILLE, NC 28677-4143
- **Practice address phone:** (704) 878-6272
- **Practice address fax:** (704) 878-6273
- **Mailing address:** 766 HARTNESS RD STE B, STATESVILLE, NC 28677-3485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/29/2025
- **Last updated:** 01/29/2025