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General NPI Number Information
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NPI Number | 1316907405
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Entity Type | Organization
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Legal Business Name | FOUR JEWELS HEALTHWAYS INC.
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 320 LILLINGTON AVE SUITE 201
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City | CHARLOTTE
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State | NC
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Zip | 28204-3130
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Country | US
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Telephone | 704-347-0049
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Fax | 704-347-0979
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Provider Business Mailing Address
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Address Line | 320 LILLINGTON AVE. SUITE 201
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City | CHARLOTTE
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State | NC
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Zip | 28204
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Country | US
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Telephone | 704-347-0049
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Fax | 704-347-0979
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MASOOD N KHAN
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Credential | M.D.,F.A.C.P
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Telephone | 704-347-0049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35007
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License Number State | NC
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