Southern Internal Medicine, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

130620 Issued in NC

Legal business name

SOUTHERN INTERNAL MEDICINE, PC

Practice address

3514 Village Dr
Fayetteville, NC 28304-4554

Phone

(910) 426-0091

Fax

(910) 426-0093

NPI assigned

Nov 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Shashikant J Patel, MD

Title

MD

Phone

(910) 426-0091

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michelle Herlihy, PA

  • Physician Assistant
  • Lumberton, NC
  • NPI 1003048679
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224201600000",
    "number": "1982778049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3514 VILLAGE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044554",
            "telephone_number": "910-426-0091",
            "fax_number": "910-426-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3514 VILLAGE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044554",
            "telephone_number": "910-426-0091",
            "fax_number": "910-426-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INTERNAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2008-10-17",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SHASHIKANT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "910-426-0091",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "130620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891208P",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeastern Radiation Oncology
• Southern Ave Rest Home
• Southern Family Markets LLC (Southern Family Market)
• Southern Healthcare Network
• Southern Hospitality Home Support Care
• Amy E. Southworth
• Karen Michelle Soutullo
• Sammy M Soza III
• Jennifer Mode Spackman, PSY.D.
• Jalen Spain

• 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 Oct 17, 2008; 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.