Individual
JACK EDWARD RUNNELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5651 POPLAR TENT RD STE 102, CONCORD, NC 28027-7686
(704) 782-4878
Mailing address
5651 POPLAR TENT RD STE 102, CONCORD, NC 28027-7686
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
2025-01850
NC
Other
Enumeration date
03/30/2022
Last updated
08/25/2025
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