Fanous Clinic Medical Group PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FANOUS CLINIC MEDICAL GROUP PC

Practice address

10926 S Tryon St Ste D
Charlotte, NC 28273-4154

Phone

(980) 224-7288

Fax

(800) 507-2885

NPI assigned

Jan 26, 2023

Last updated

Aug 16, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Hany FaragNPI 1538362066

Title

Owner

Phone

(980) 224-7288

Specialties & licenses 3

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Hany Latif Moufid Farag, MD

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1538362066
  NPD Authorized official
• Tory Strider Grooms, PHARMD, CPP

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Charlotte, NC
  • NPI 1801415187
  NPD

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

{
    "created_epoch": "1674691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1275249898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10926 S TRYON ST STE D",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282734154",
            "telephone_number": "980-224-7288",
            "fax_number": "800-507-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10926 S TRYON ST STE D",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282734154",
            "telephone_number": "980-224-7288",
            "fax_number": "800-507-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANOUS CLINIC MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-26",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "FARAG",
        "authorized_official_first_name": "HANY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-224-7288"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fancy Feet Foot Care Center (Fffcc)
• Glen Anthony Fandetti, MD
• Heather Fangman, LPCA
• Mongai Fankam
• Kashmia A Fanning, MSW, LCSWA
• Kayla Fant
• Shelley Lanette Fant
• Oluwafunmilayo Ruth Fapohunda, MD
• Jordan Grace Farabow, LMFTA
• David Farache

• Internal Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.