# IREDELL PHYSICIAN NETWORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Iredell Occupational Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780061424
- **Authorized official:** CARLA D JOHNSON (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (704) 495-3162

## Contact information

- **Practice address:** 653 BLUEFIELD RD, STE B, MOORESVILLE, NC 28117
- **Practice address phone:** (980) 444-2630
- **Practice address fax:** (980) 444-2631
- **Mailing address:** PO BOX 896199, CHARLOTTE, NC 28289-6199
- **Mailing address phone:** (833) 936-1364
- **Mailing address fax:** (605) 942-7505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/01/2015
- **Last updated:** 07/28/2021