Provider Demographics
NPI:1427095231
Name:ANDERSON FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:ANDERSON FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-283-8888
Mailing Address - Street 1:1301 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5012
Mailing Address - Country:US
Mailing Address - Phone:704-283-8888
Mailing Address - Fax:
Practice Address - Street 1:1301 DOVE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5012
Practice Address - Country:US
Practice Address - Phone:704-283-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903343Medicaid
NC5177FOtherBCBS/NC
NC017WAOtherBCBS/NC
NC017WAOtherBCBS/NC