Organization
SOUTHEASTERN SPECIALIST CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R. MILES JR. M.D. (PRESIDENT/OWNER)
(704) 867-8975
Entity
Organization
Contact information
Practice address
825 MAJESTIC CT, SUITE F, GASTONIA, NC 28054-5186
(704) 867-8975
(704) 867-8353
Mailing address
825 MAJESTIC COURT, SUITE F, GASTONIA, NC 28054
(704) 867-8975
(704) 867-8353
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
19633
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8958807
—
NC
Enumeration date
01/05/2006
Last updated
08/22/2020
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