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Organization
STANLY FAMILY CARE CLINIC PA
Active
Organization
STANLY FAMILY CARE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC MERRIMAN JOHNSEN M.D. (PRESIDENT)
(704) 983-3121
Entity
Organization
Contact information
Practice address
1007 N 6TH ST, ALBEMARLE, NC 28001-3551
(704) 983-3121
(704) 983-4659
Mailing address
1007 N 6TH ST, ALBEMARLE, NC 28001-3551
(704) 983-3121
(704) 983-4659
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24425
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0243C
BCBS GROUP
NC
01
—
080077493
RAILROAD MEDICARE
NC
01
—
46027
BCBS IND.
NC
05
—
890243C
—
NC
Enumeration date
05/23/2006
Last updated
03/04/2008
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