Individual
DR. LAURIE BUMGARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1918 RANDOLPH RD, SUITE 175, CHARLOTTE, NC 28207-1100
(704) 316-1050
(704) 316-1051
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(704) 316-1050
(704) 316-1051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38018
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2159218D
—
NC
Enumeration date
01/23/2006
Last updated
10/29/2020
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