Organization
EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP OF LAKE NORMAN, P.A.
Active
Parent organization
EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP, P.A.
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP, P.A.
Authorized official
DR. JOHN EDWARD HUMPHREY M.D. (PRESIDENT)
(704) 362-2663
Entity
Organization
Contact information
Practice address
20723 TORRENCE CHAPEL RD, SUITE 203, CORNELIUS, NC 28031-6496
(704) 987-2560
(704) 987-2561
Mailing address
20723 TORRENCE CHAPEL RD, SUITE 203, CORNELIUS, NC 28031-6496
(704) 987-2560
(704) 987-2561
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
144566
NC
Other
Enumeration date
10/09/2009
Last updated
10/09/2009
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