Healthcare Provider Details

I. General information

NPI: 1003764432
Provider Name (Legal Business Name): HORIZON MEDICAL, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 ANCHORAGE LN
TEGA CAY SC
29708-8523
US

IV. Provider business mailing address

29 LITTLE NASSAU ST STE 102
BROOKLYN NY
11205-5267
US

V. Phone/Fax

Practice location:
  • Phone: 704-231-4571
  • Fax:
Mailing address:
  • Phone: 704-231-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WASEEM GHANNAM
Title or Position: PRESIDENT
Credential: MD
Phone: 704-231-4571