Provider Demographics
NPI:1346564424
Name:AWAREMED WHOLISTIC URGENT CARE PLLC
Entity Type:Organization
Organization Name:AWAREMED WHOLISTIC URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DALAL
Authorized Official - Middle Name:ANIS
Authorized Official - Last Name:AKOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-315-2520
Mailing Address - Street 1:4710 OLEANDER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5898
Mailing Address - Country:US
Mailing Address - Phone:843-213-1480
Mailing Address - Fax:843-712-1973
Practice Address - Street 1:4710 OLEANDER DRIVE
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5898
Practice Address - Country:US
Practice Address - Phone:843-213-1480
Practice Address - Fax:843-712-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC980006208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00387371OtherRAILROAD MEDICARE
TN3136318OtherBLUE CROSS BLUE SHIELD
TN3069481Medicare PIN
TNP00387371OtherRAILROAD MEDICARE