Provider Demographics
NPI:1669729349
Name:ADCOCK, ARTHUR LEE II (CRNA)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:LEE
Last Name:ADCOCK
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:131 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8522
Mailing Address - Country:US
Mailing Address - Phone:704-662-0876
Mailing Address - Fax:704-662-0875
Practice Address - Street 1:131 MEDICAL PARK RD
Practice Address - Street 2:SUITE 308
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8522
Practice Address - Country:US
Practice Address - Phone:704-662-0876
Practice Address - Fax:704-662-0875
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC256229367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered