Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 102512 | NC |
NPI | 1841257508 |
---|---|
Provider Name | Roy G. Waronsky |
First Address | Mooresville, NC 28115-2588 |
Second Address | Mooresville, NC 28115-2581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 01/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S42985 | (02) |