Organization
CAROMONT MEDICAL GROUP INC
Active
Parent organization
CAROMONT MEDICAL GROUP INC
Other names
Gastonia Surgical Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROMONT MEDICAL GROUP INC
Authorized official
DOUGLAS LUCKETT (PRESIDENT, CEO)
(704) 834-2133
Entity
Organization
Contact information
Practice address
2544 COURT DR, STE H, GASTONIA, NC 28054-3450
(704) 864-7821
(704) 884-0087
Mailing address
2544 COURT DR, STE H, GASTONIA, NC 28054-3450
(704) 864-7821
(704) 884-0087
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024W5
BCBS
NC
05
—
5917956
—
NC
Enumeration date
04/11/2011
Last updated
02/03/2017
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