Individual
LORD NACEP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
G.C.
Contact information
Practice address
2605 BOOKER AVE, CHARLOTTE, NC 28216-4910
(704) 456-2192
(704) 334-9108
Mailing address
2605 BOOKER AVE, CHARLOTTE, NC 28216-4910
(704) 456-2192
(704) 334-9108
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
50597
NC
171WH0202X
Home Modifications Contractor
Primary
50597
NC
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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