Organization
CHERRYVILLE PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL L WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
112 OAK ST, CHERRYVILLE, NC 28021-3423
(980) 487-2200
(704) 435-3295
Mailing address
PO BOX 601884, CHARLOTTE, NC 28260-1884
(980) 487-2200
(704) 435-3295
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89011UC
—
NC
Enumeration date
07/02/2006
Last updated
07/08/2013
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