Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake Norman Surgical Assisting

Organization Surgical Physician Assistant · NPI 1093005878

Lake Norman Surgical Assisting is a Surgical Physician Assistant in Mooresville, North Carolina. Licensed in North Carolina. Registered with an NPI since 2011.

Licensed in
NC
In the registry since
2011

Practice location Address checks out

1130 Grace Meadow Dr
Mooresville, NC 28115-2789
Phone: (704) 663-4989
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 101593 (NC)

Record details

NPI number1093005878
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Charles Tudor — Managing Partner · (704) 663-4989
NPI enumeratedApril 13, 2011
Last updated in NPPESApril 1, 2014
Mailing address1130 Grace Meadow Dr, Mooresville, NC 28115-2789

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