Individual
GINA LICAUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 E WT HARRIS BLVD, STE 5002, CHARLOTTE, NC 28262-3485
(704) 801-7310
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35695
NC
Other
Enumeration date
09/30/2005
Last updated
09/27/2021
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