# LAKE NORMAN PAIN AND WEIGHT MANAGEMENT, LLC

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

## Provider details

- **NPI number:** 1720395783
- **Authorized official:** MRS. CHRISSY GAYLE FOHR NPC (NURSE PRACTITIONER)
- **Authorized official phone:** (336) 414-1164

## Contact information

- **Practice address:** 378 WILLIAMSON RD STE 204, MOORESVILLE, NC 28117-5917
- **Practice address phone:** (704) 662-0009
- **Practice address fax:** (704) 360-2335
- **Mailing address:** 378 WILLIAMSON RD STE 204, MOORESVILLE, NC 28117-5917
- **Mailing address phone:** (704) 662-0009
- **Mailing address fax:** (704) 360-2335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 5004119 | NC | Yes |

## Other

- **Enumeration date:** 09/10/2010
- **Last updated:** 03/18/2024