Organization
INTERVENTIONAL PAIN MANAGEMENT OF LAKE NORMAN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM J EDMISTON JR. MD (OWNER)
(704) 360-4378
Entity
Organization
Contact information
Practice address
170 MEDICAL PARK RD, SUITE 301, MOORESVILLE, NC 28117-8540
(704) 360-4378
Mailing address
170 MEDICAL PARK RD, SUITE 301, MOORESVILLE, NC 28117-8540
(704) 360-4378
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
200000410
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891269N
—
NC
Enumeration date
03/09/2011
Last updated
03/07/2023
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