Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2021-00710 | NC |
NPI | 1003311903 |
---|---|
Provider Name | Leslie Adcock |
First Address | Charlotte, NC 28219-9305 |
Second Address | Denver, NC 28037-9514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2018 |
Last Update Date | 05/01/2022 |