Healthcare Provider Details

I. General information

NPI: 1902358294
Provider Name (Legal Business Name): INTEGRATIVE RHEUMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10826 MALLARD CREEK RD STE 100
CHARLOTTE NC
28262-7785
US

IV. Provider business mailing address

10826 MALLARD CREEK RD STE 100
CHARLOTTE NC
28262-7785
US

V. Phone/Fax

Practice location:
  • Phone: 704-774-3044
  • Fax: 704-774-3045
Mailing address:
  • Phone: 704-774-3044
  • Fax: 704-774-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2013-01881
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES ALBERT WITHERS II
Title or Position: OWNER/CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 919-475-9243