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Organization
SOUTHERN CLINIC AND URGT CAR
Active
Organization
SOUTHERN CLINIC AND URGT CAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUGUSTINE R EZE MD (PRESIDENT)
(704) 865-2755
Entity
Organization
Contact information
Practice address
3420 FILBERT HWY, CLOVER, SC 29710-5602
(803) 222-0600
(803) 222-6119
Mailing address
PO BOX 550490, GASTONIA, NC 28055-0490
(704) 865-2755
(704) 865-5013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3252
—
SC
Enumeration date
01/11/2006
Last updated
04/20/2008
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