Provider Demographics
NPI:1649977224
Name:DRS FARRELL FARRELL NALE COOK KAPITAN MOHAMED FRANCO WESSEL HOWELL & K
Entity type:Organization
Organization Name:DRS FARRELL FARRELL NALE COOK KAPITAN MOHAMED FRANCO WESSEL HOWELL & K
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING & CREDENTIA
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RAYLE
Authorized Official - Last Name:HOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-295-4653
Mailing Address - Street 1:5550 77 CENTER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-0739
Mailing Address - Country:US
Mailing Address - Phone:704-295-4653
Mailing Address - Fax:
Practice Address - Street 1:104 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3334
Practice Address - Country:US
Practice Address - Phone:704-295-4653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS FARRELL FARRELL NALE COOK KAPITAN MOHAMED FRANCO WESSEL HOWELL & K
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-14
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty