# ADVANCED SPORTS & SPINE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629422738
- **Authorized official:** DR. USMAN FAYYAZ AHMAD D.O. (SOLE MEMBER)
- **Authorized official phone:** (704) 542-3988

## Contact information

- **Practice address:** 8035 PROVIDENCE RD, \#340, CHARLOTTE, NC 28277-9716
- **Practice address phone:** (704) 542-3988
- **Mailing address:** 8035 PROVIDENCE RD STE 340, CHARLOTTE, NC 28277-9717
- **Mailing address phone:** (704) 542-3988
- **Mailing address fax:** (704) 542-3912

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 2015-01401 | NC | Yes |

## Other

- **Enumeration date:** 04/15/2016
- **Last updated:** 04/12/2018