Most Relevant Information
Provider Data
| NPI Number: | 1003471103 |
| Provider Name: | ANNE MARIE LACKEY GORDON PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 0010-12193 |
Most Important Dates
| Enumeration Date: | 05/03/2019 |
| Last Updated: | 07/15/2024 |
Provider Practice Location
709 N DEKALB ST
SHELBY
NC
281503911
Practice Location Phone/Fax
| Phone: | 9804872100 |
| Fax: |
Provider Mailing Location
PO BOX 19305
CHARLOTTE
NC
282199305
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |