Organization
EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN EDWARD HUMPHREY M.D. (PRESIDENT)
(704) 362-2663
Entity
Organization
Contact information
Practice address
3303 LATROBE DR, CHARLOTTE, NC 28211-4851
(704) 362-2663
(704) 362-2836
Mailing address
3303 LATROBE DR, CHARLOTTE, NC 28211-4851
(704) 362-2663
(704) 362-2836
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
07/11/2006
Last updated
05/02/2011
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