Healthcare Provider Details

I. General information

NPI: 1184894271
Provider Name (Legal Business Name): GREENVILLE NEPHROLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4085 OHIO DR SUITE 100
FRISCO TX
75035-6240
US

IV. Provider business mailing address

4085 OHIO DR SUITE 100
FRISCO TX
75035-6240
US

V. Phone/Fax

Practice location:
  • Phone: 972-668-9713
  • Fax: 214-446-9460
Mailing address:
  • Phone: 972-668-9713
  • Fax: 214-446-9460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM1218
License Number StateTX

VIII. Authorized Official

Name: DR. KHALID MAHMOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-668-9713