Organization
PRIMEDOC OF STANLY COUNTY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT REYNOLDS MD (PRESIDENT)
(828) 210-3260
Entity
Organization
Contact information
Practice address
301 YADKIN ST, ALBEMARLE, NC 28001-3441
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 751395, CHARLOTTE, NC 28275-1395
(843) 237-3378
(843) 237-5073
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012WK
BLUE CROSS BLUE SHIELD
NC
05
—
89012WK
—
NC
01
—
CJ3931
RAILROAD MEDICARE
NC
Enumeration date
04/21/2006
Last updated
03/17/2009
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