Individual
TSIMMENG JUSTIN THAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
201 E GROVER ST, SHELBY, NC 28150-3917
(704) 512-5124
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2019-02393
NC
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
2019-02393
NC
Other
Enumeration date
03/16/2016
Last updated
07/15/2024
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