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General NPI Number Information
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NPI Number | 1902358294
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE RHEUMATOLOGY PLLC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 10826 MALLARD CREEK RD STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28262-7785
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Country | US
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Telephone | 704-774-3044
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Fax | 704-774-3045
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Provider Business Mailing Address
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Address Line | 10826 MALLARD CREEK RD STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28262-7785
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Country | US
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Telephone | 704-774-3044
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Fax | 704-774-3045
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Authorized Official
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Title or Position | OWNER/CHIEF EXECUTIVE OFFICER
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Name | DR. CHARLES ALBERT WITHERS II
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Credential | MD
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Telephone | 919-475-9243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 2013-01881
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License Number State | NC
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