Organization
LAKE NORMAN UROLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. G ANNE HAGE (OFFICE ADMIN)
(704) 660-3322
Entity
Organization
Contact information
Practice address
137 PROFESSIONAL PARK DRIVE, SUITE D, MOORESVILLE, NC 28117-8522
(704) 660-3322
(704) 660-3330
Mailing address
137 PROFESSIONAL PARK DRIVE, SUITE D, MOORESVILLE, NC 28117-8522
(704) 660-3322
(704) 660-3330
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
790279R
—
NC
Enumeration date
05/16/2006
Last updated
08/22/2020
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