Provider Demographics
NPI:1548401888
Name:HORMONAL HEALTH AND WELLNESS CENTER, P.A.
Entity Type:Organization
Organization Name:HORMONAL HEALTH AND WELLNESS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:GAUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:704-896-1876
Mailing Address - Street 1:16600 BIRKDALE CMNS PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6181
Mailing Address - Country:US
Mailing Address - Phone:704-896-1876
Mailing Address - Fax:704-624-3841
Practice Address - Street 1:16600 BIRKDALE CMNS PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6181
Practice Address - Country:US
Practice Address - Phone:704-896-1876
Practice Address - Fax:704-624-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27047208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC27047OtherNC MEDICAL LICENSE
NCC81783Medicare UPIN