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

South Park Medical Clinic PA

Organization Family Medicine Physician · NPI 1083614564

South Park Medical Clinic PA is a Family Medicine Physician in Hickory, North Carolina. Licensed in North Carolina. Registered with an NPI since 2005.

Licensed in
NC
In the registry since
2005
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

133 1st Ave SE
Hickory, NC 28602-3005
Phone: (828) 322-5915
Fax: (828) 345-0387
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 21863 (NC)

Record details

NPI number1083614564
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Elbert Rudisill — President · (828) 322-5915
NPI enumeratedJuly 27, 2005
Last updated in NPPESAugust 22, 2020
Mailing address133 1st Ave Se, Hickory, NC 28602-3005

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