Provider Demographics
NPI:1275126757
Name:FUNCTIONAL MEDICINE CENTER OF THE CAROLINAS PC
Entity Type:Organization
Organization Name:FUNCTIONAL MEDICINE CENTER OF THE CAROLINAS PC
Other - Org Name:FUNCTIONAL MEDICINE CENTER OF THE CAROLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-770-6847
Mailing Address - Street 1:14928 OLD VERMILLION DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5337
Mailing Address - Country:US
Mailing Address - Phone:704-770-6847
Mailing Address - Fax:
Practice Address - Street 1:400 GILEAD RD # 1555
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6899
Practice Address - Country:US
Practice Address - Phone:704-274-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty