Fayetteville Geriatric & Internal Medicine Clinic PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FAYETTEVILLE GERIATRIC & INTERNAL MEDICINE CLINIC PA

Practice address

3616 Cape Center Dr
Suite a
Fayetteville, NC 28304

Phone

(910) 868-6730

Fax

(910) 829-9649

NPI assigned

Sep 6, 2006

Last updated

Jun 11, 2014By 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

Mohammed Rahman, MD

Title

Doctor

Phone

(910) 868-6730

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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.

• Mekka Jamelia Tucker, RN, BSN

  • Administrator Registered Nurse
  • Fayetteville, NC
  • NPI 1306632021
  NPD

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402444800000",
    "number": "1649373788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1689",
            "city": "ETOWAH",
            "state": "NC",
            "postal_code": "287291689",
            "telephone_number": "828-891-5524",
            "fax_number": "828-891-4069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3616 CAPE CENTER DR",
            "address_2": "SUITE A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28304",
            "telephone_number": "910-868-6730",
            "fax_number": "910-829-9649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE GERIATRIC & INTERNAL MEDICINE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2014-06-11",
        "status": "A",
        "authorized_official_last_name": "RAHMAN",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "910-868-6730",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1163K",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891163K",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Fayetteville, NC
• Providers in Fayetteville, 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 Jun 11, 2014; 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.