Provider Demographics
NPI:1235152422
Name:ANSON COUNTY INTERNAL MEDICINE CLINIC, P.A.
Entity Type:Organization
Organization Name:ANSON COUNTY INTERNAL MEDICINE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDOLHAKIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NIAZI-SAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP FRCP C
Authorized Official - Phone:704-694-5159
Mailing Address - Street 1:208 HALL STREET
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170
Mailing Address - Country:US
Mailing Address - Phone:704-694-5159
Mailing Address - Fax:704-694-2003
Practice Address - Street 1:208 HALL STREET
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170
Practice Address - Country:US
Practice Address - Phone:704-694-5159
Practice Address - Fax:704-694-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19810207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01043OtherBCBS
NC7901043Medicaid
NC0306Medicare ID - Type Unspecified
NC7901043Medicaid