MEDICARE: GERIATRIC CARE OF THE CAROLINAS, 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1538700745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC CARE OF THE CAROLINAS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 102
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28070-0102
Country	:	US
Telephone Number	:	704-232-0635
Fax Number	:	704-866-0103

Provider Business Practice Location Address
First Line	:	6001 GRABURNS FORD DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7120
Country	:	US
Telephone Number	:	704-232-0635
Fax Number	:	704-866-0103

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	SHAKEER MAHMOOD
Credential	:	MD
Telephone Number	:	704-232-0635

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	01/02/2020

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