Organization Active NPI

Low-T Physicians Professional Association

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1053880518
Registry record updated Nov 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LOW-T PHYSICIANS PROFESSIONAL ASSOCIATION
Doing business as
Physician Wellness Professional Association
Practice address
10430 Park Road Suite 100a
Charlotte, NC 28210
Phone
(704) 259-7933
Fax
(704) 899-5658
NPI assigned
Nov 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William G Reilly, MD
Title
Authorized Official
Phone
(817) 410-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

10430 Park Road Suite 100a
Charlotte, NC 28210

Mailing address

1920 East State Highway 114
Southlake, TX 76092
Phone (817) 410-3800

Other names 1

  • Physician Wellness Professional Association Doing business as

National Provider Directory

National Provider Directory

Locations

10430 Park Rd
Ste 100A
Charlotte, NC 28210
Phone (704) 259-7673

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542153600000",
    "number": "1053880518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 EAST STATE HIGHWAY 114",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-410-3800",
            "fax_number": "817-410-6466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10430 PARK ROAD SUITE 100A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28210",
            "telephone_number": "704-259-7933",
            "fax_number": "704-899-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOW-T PHYSICIANS PROFESSIONAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-14",
        "last_updated": "2018-11-14",
        "status": "A",
        "authorized_official_last_name": "REILLY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "817-410-3800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physician Wellness Professional Association",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.