Provider Demographics
NPI:1548609134
Name:ANDERSON, EMILY AIKEN (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:AIKEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:445 PINEVIEW DR
Practice Address - Street 2:SUITE 220
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3817
Practice Address - Country:US
Practice Address - Phone:336-993-8573
Practice Address - Fax:336-993-8319
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-04300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-04300OtherNC MEDICAL LICENSE