# NEOGENIX LAKE NORMAN, PC

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

## Provider details

- **NPI number:** 1730903436
- **Authorized official:** MR. NIKITAS WILLIAM MILES (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (704) 727-6551

## Contact information

- **Practice address:** 19475 OLD JETTON RD STE 102, CORNELIUS, NC 28031-6591
- **Practice address phone:** (704) 727-6551
- **Practice address fax:** (704) 669-8670
- **Mailing address:** 16147 LANCASTER HWY STE 140, CHARLOTTE, NC 28277-4782
- **Mailing address phone:** (704) 727-6551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/11/2024
- **Last updated:** 11/11/2024