Provider Demographics
NPI:1174561815
Name:PIEDMONT ENDOCRINOLOGY, INC.
Entity type:Organization
Organization Name:PIEDMONT ENDOCRINOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HATIM
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-791-4070
Mailing Address - Street 1:PO BOX 16414
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6414
Mailing Address - Country:US
Mailing Address - Phone:866-497-8332
Mailing Address - Fax:919-967-6647
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2927
Practice Address - Country:US
Practice Address - Phone:434-791-4070
Practice Address - Fax:434-791-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234987207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA289591OtherBC/BS - MAHMOUD
NC890668GMedicaid
NC890668GMedicaid