Organization
SOUTH IREDELL INTERNAL MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN B BLACKBURN MD (PRESIDENT)
(704) 664-5131
Entity
Organization
Contact information
Practice address
146 MEDICAL PARK RD STE 106, MOORESVILLE, NC 28117-8529
(704) 664-5131
(704) 664-7547
Mailing address
146 MEDICAL PARK RD STE 106, MOORESVILLE, NC 28117-8529
(704) 664-5131
(704) 664-7547
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
29531
NC
Other
Enumeration date
09/26/2006
Last updated
05/19/2016
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