Provider Demographics
NPI:1558490664
Name:MERCY MEDICAL CLINIC, P. A.
Entity Type:Organization
Organization Name:MERCY MEDICAL CLINIC, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAZLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-736-0400
Mailing Address - Street 1:PO BOX 10707
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27532-0707
Mailing Address - Country:US
Mailing Address - Phone:919-736-0400
Mailing Address - Fax:919-736-0426
Practice Address - Street 1:2501 WAYNE MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9436
Practice Address - Country:US
Practice Address - Phone:919-736-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335016Medicare ID - Type Unspecified