Organization
BEHAVIORAL HEALTHCARE & MEMORY INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREM K MUTHU MD (DIRECTOR)
(704) 878-8884
Entity
Organization
Contact information
Practice address
215B W BROAD ST, STATESVILLE, NC 28677-5259
(704) 878-8884
(704) 878-8883
Mailing address
215B W BROAD ST, STATESVILLE, NC 28677-5259
(704) 878-8884
(704) 878-8883
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
82239
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0292J
BLUE CROSS BLUE SHIELD GR
NC
05
—
890292J
—
NC
Enumeration date
03/19/2007
Last updated
08/22/2020
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