Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2014-02193 | NC |
NPI | 1003172990 |
---|---|
Provider Name | Faith Lockett Gardner |
First Address | Charlotte, NC 28260-2658 |
Second Address | Lexington, NC 27292-6768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 30/06/2016 |