=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386606556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEROKEE INTERNAL MEDICINE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2006
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 W MONTGOMERY STREET
-----------------------------------------------------
City | GAFFNEY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-488-1514
-----------------------------------------------------
Fax | 864-488-0552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 W MONTGOMERY STREET
-----------------------------------------------------
City | GAFFNEY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-488-1514
-----------------------------------------------------
Fax | 864-488-0552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALFRED T EZMAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 864-488-1514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0687
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------