Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southpark Functional Medicine PLLC

Organization Internal Medicine Physician · NPI 1275223638

Southpark Functional Medicine PLLC is an Internal Medicine Physician in Charlotte, North Carolina. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5950 Fairview Rd Ste 406
Charlotte, NC 28210-3113
Phone: (704) 560-3316
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1275223638
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Sarita Mahtani — Physician · (704) 560-3316
NPI enumeratedMay 10, 2023
Last updated in NPPESAugust 2, 2023
Certification dateAugust 2, 2023
Mailing address5950 Fairview Rd Ste 406, Charlotte, NC 28210-3113

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