# SOUTHEAST STONE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeast Stone Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588718100
- **Authorized official:** JUDY H RUSSELL (BUSINESS SERVICES COORDINATOR)
- **Authorized official phone:** (704) 896-2120

## Contact information

- **Practice address:** 705 GRIFFITH ST STE 205, DAVIDSON, NC 28036-9307
- **Practice address phone:** (866) 828-0173
- **Mailing address:** 705 GRIFFITH ST STE 205, PO BOX 4509, DAVIDSON, NC 28036-9307
- **Mailing address phone:** (866) 828-0173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QL0400X | Lithotripsy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 08/22/2020