South Iredell Internal Medicine, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

29531 Issued in NC

Legal business name

SOUTH IREDELL INTERNAL MEDICINE, PA

Practice address

146 Medical Park Rd Ste 106
Mooresville, NC 28117-8529

Phone

(704) 664-5131

Fax

(704) 664-7547

NPI assigned

Sep 26, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Brian B Blackburn, MD

Title

President

Phone

(704) 664-5131

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1952402364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 MEDICAL PARK RD STE 106",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178529",
            "telephone_number": "704-664-5131",
            "fax_number": "704-664-7547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 MEDICAL PARK RD STE 106",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178529",
            "telephone_number": "704-664-5131",
            "fax_number": "704-664-7547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH IREDELL INTERNAL MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2016-05-19",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-664-5131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "29531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cody Solesbee, PH.D.
• Daniel Sonntag, CRNA
• Anna Miller Soper, LCAS, LCMHCA
• Christian Finn Sorensen, M.D.
• Elizabeth Meier Soriano, MA, CCC- SLP
• Laura Souther
• Southern Family Medicine, Inc.
• Tondra L Sowell, MA
• Sherard Huffstetler Spangler, PA-C
• Daisy J Sparks, LMBT 11742

• Specialist in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; 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.