Individual
ALA STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1025 MOREHEAD MEDICAL DR, SUITE 275, CHARLOTTE, NC 28204-2963
(704) 403-2662
Mailing address
1025 MOREHEAD MEDICAL DR, CHARLOTTE, NC 28204-2963
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2014-00902
NC
Other
Enumeration date
08/15/2006
Last updated
11/08/2018
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