Eastover Psychological & Psychiatric Group of Lake Norman, P.a.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

144566 Issued in NC

Legal business name

EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP OF LAKE NORMAN, P.A.

Practice address

20723 Torrence Chapel Rd
Suite 203
Cornelius, NC 28031-6496

Phone

(704) 987-2560

Fax

(704) 987-2561

NPI assigned

Oct 9, 2009

Organization subpart

Yes

Parent organization

EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP, P.A.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Edward Humphrey, M.D.

Title

President

Phone

(704) 362-2663

Specialties & licenses 1

Addresses

Part of

Eastover Psychological Psy

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255046400000",
    "number": "1982939823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20723 TORRENCE CHAPEL RD",
            "address_2": "SUITE 203",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316496",
            "telephone_number": "704-987-2560",
            "fax_number": "704-987-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20723 TORRENCE CHAPEL RD",
            "address_2": "SUITE 203",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316496",
            "telephone_number": "704-987-2560",
            "fax_number": "704-987-2561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP OF LAKE NORMAN, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP, P.A.",
        "enumeration_date": "2009-10-09",
        "last_updated": "2009-10-09",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-362-2663",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "144566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.