Provider Demographics
NPI:1629024138
Name:NORTH STATE MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:NORTH STATE MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:AHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-483-2200
Mailing Address - Street 1:9816 SAM FURR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4930
Mailing Address - Country:US
Mailing Address - Phone:704-483-2200
Mailing Address - Fax:704-483-2214
Practice Address - Street 1:2266 N HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8254
Practice Address - Country:US
Practice Address - Phone:704-483-2200
Practice Address - Fax:704-483-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890131UMedicaid
NC890131UMedicaid