Organization
FAYETTEVILLE GERIATRIC & INTERNAL MEDICINE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMED RAHMAN MD (DOCTOR)
(910) 868-6730
Entity
Organization
Contact information
Practice address
3616 CAPE CENTER DR, SUITE A, FAYETTEVILLE, NC 28304
(910) 868-6730
(910) 829-9649
Mailing address
PO BOX 1689, ETOWAH, NC 28729-1689
(828) 891-5524
(828) 891-4069
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1163K
BLUE CROSS BLUE SHIELD
—
05
—
891163K
—
NC
Enumeration date
09/06/2006
Last updated
06/11/2014
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