Organization
IREDELL RADIOLOGY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERRY WILSON (OFFICE MANAGER)
(704) 872-6122
Entity
Organization
Contact information
Practice address
548 BROOKDALE DR, STATESVILLE, NC 28677-4108
(704) 872-6122
Mailing address
548 BROOKDALE DR, STATESVILLE, NC 28677-4108
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890184B
—
NC
Enumeration date
05/02/2006
Last updated
07/08/2010
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