Provider Demographics
NPI:1114709003
Name:SOUTH CHARLOTTE RHEUMATOLOGY, PLLC
Entity Type:Organization
Organization Name:SOUTH CHARLOTTE RHEUMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-672-0449
Mailing Address - Street 1:8840 BLAKENEY PROFESSIONAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6806
Mailing Address - Country:US
Mailing Address - Phone:704-672-0449
Mailing Address - Fax:
Practice Address - Street 1:8840 BLAKENEY PROFESSIONAL DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6806
Practice Address - Country:US
Practice Address - Phone:704-672-0449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site