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General NPI Number Information
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NPI Number | 1114998671
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Entity Type | Individual
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Provider Name | HUSAM MOURTADA MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 1330 BOILING SPRINGS RD SUITE 1800
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City | SPARTANBURG
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State | SC
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Zip | 29303-4201
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Country | US
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Telephone | 864-560-9646
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 743070
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City | ATLANTA
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State | GA
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Zip | 30374-3070
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Country | US
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Telephone | 864-560-4304
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Fax | 864-560-4413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 26527
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License Number State | SC
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