MEDICARE: AWAREMED WHOLISTIC URGENT CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	980006	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00387371	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	3136318	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1346564424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWAREMED WHOLISTIC URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	4710 OLEANDER DRIVE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5898
Country	:	US
Telephone Number	:	843-213-1480
Fax Number	:	843-712-1973

Provider Business Practice Location Address
First Line	:	4710 OLEANDER DRIVE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5898
Country	:	US
Telephone Number	:	843-213-1480
Fax Number	:	843-712-1973

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DALAL ANIS AKOURY
Credential	:	M.D.
Telephone Number	:	843-315-2520

Provider Enumeration Date	:	03/18/2010
Last Update Date	:	12/29/2011

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