Provider Demographics
NPI:1558879965
Name:SOUTHERN ONCOLOGY SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:SOUTHERN ONCOLOGY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-659-7848
Mailing Address - Street 1:9930 KINCEY AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6541
Mailing Address - Country:US
Mailing Address - Phone:704-947-5005
Mailing Address - Fax:877-881-8455
Practice Address - Street 1:9930 KINCEY AVE STE 165
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6541
Practice Address - Country:US
Practice Address - Phone:704-947-5005
Practice Address - Fax:877-881-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336S0011X
NC130893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy