Individual
JONATHAN MICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
214 E FRANKLIN BLVD STE 11, GASTONIA, NC 28052-4106
(980) 522-4300
Mailing address
1719 HAYNES AVE, GASTONIA, NC 28052-1431
(980) 522-4300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
332783
NC
Other
Enumeration date
12/26/2024
Last updated
12/26/2024
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