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General NPI Number Information
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NPI Number | 1912987975
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Entity Type | Individual
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Provider Name | WILLIAM G. KATIBAH III M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 10320 MALLARD CREEK RD SUITE 100
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City | CHARLOTTE
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State | NC
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Zip | 28262-9756
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Country | US
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Telephone | 704-517-2130
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Fax | 877-539-3581
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Provider Business Mailing Address
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Address Line | 304 BILLINGS PL
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-8506
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Country | US
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Telephone | 704-517-2130
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Fax | 704-626-2656
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31155
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License Number State | NC
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