Organization
EMERGENT LIFE INTEGRATIVE MEDICINE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARANY JEGANATTH (FOUNDER, GENERAL MANAGER)
(919) 961-2204
Entity
Organization
Contact information
Practice address
5104 REAGAN DRIVE, SUITE 4, CHARLOTTE, NC 28206-1392
(919) 961-2204
Mailing address
5104 REAGAN DRIVE, SUITE 4, CHARLOTTE, NC 28206-1392
(919) 961-2204
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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