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General NPI Number Information
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NPI Number | 1336455674
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Entity Type | Organization
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Legal Business Name | SOUTHERN ONCOLOGY SPECIALISTS, PLLC
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 9930 KINCEY AVE STE 165
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-6541
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Country | US
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Telephone | 704-947-5005
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Fax | 877-881-8455
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Provider Business Mailing Address
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Address Line | 9930 KINCEY AVE STE 165
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-6541
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Country | US
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Telephone | 47-947-5005
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Fax | 877-881-8455
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. WILLIAM R MITCHELL
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Credential | MD
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Telephone | 704-945-6843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 34407
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 13089
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 34407
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License Number State | NC
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