Organization
GASTON PRIMARY CARE PLLC
Active
Organization
GASTON PRIMARY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AZEMOBO CHARLES AKHIMIEN MD (PRESIDENT)
(704) 864-5969
Entity
Organization
Contact information
Practice address
760 N NEW HOPE RD, SUITE B, GASTONIA, NC 28054-4037
(704) 864-5969
(704) 864-5584
Mailing address
PO BOX 550802, GASTONIA, NC 28055-0802
(704) 864-5969
(704) 864-5584
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
200000171
NC
207R00000X
Internal Medicine Physician
23016
SC
207R00000X
Internal Medicine Physician
51287
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891255W
—
NC
Enumeration date
05/01/2006
Last updated
07/26/2011
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