Organization
INTEGRATIVE KIDNEY ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KALILIAH WILSON (CREDENTIALING SPECIALIST)
(404) 287-3212
Entity
Organization
Contact information
Practice address
421 S SHARON AMITY RD STE B, CHARLOTTE, NC 28211-2882
(704) 826-3722
(404) 506-9090
Mailing address
421 S SHARON AMITY RD STE B, CHARLOTTE, NC 28211-2882
(704) 826-3722
(404) 506-9090
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5911907
—
NC
Enumeration date
03/15/2022
Last updated
10/02/2023
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