Individual
WILLIAM JOHN EDMISTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
170 MEDICAL PARK RD, SUITE 301, MOORESVILLE, NC 28117-8540
(704) 360-4378
(704) 696-8150
Mailing address
170 MEDICAL PARK RD, SUITE 301, MOORESVILLE, NC 28117-8540
(704) 360-4378
(704) 696-8150
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
200000410
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891269N
—
NC
Enumeration date
08/30/2006
Last updated
03/07/2023
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