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Organization

LAKESIDE SURGICAL ASSOCIATES, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GREGORY B HALL M. D., F.A.C.S (PRESIDENT)
(704) 664-6677
Entity
Organization

Contact information

Practice address
150 FAIRVIEW RD, SUITE 300, MOORESVILLE, NC 28117-9504
(704) 664-6677
(704) 663-1009
Mailing address
150 FAIRVIEW RD, SUITE 300, MOORESVILLE, NC 28117-9504
(704) 664-6677
(704) 663-1009

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9600335
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8938320
NC
Enumeration date
01/25/2007
Last updated
07/06/2010
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