Healthcare Provider Details

I. General information

NPI: 1386152247
Provider Name (Legal Business Name): TOWN CENTER PODIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BAKER RD
ARCHDALE NC
27263
US

IV. Provider business mailing address

140 BAKER RD
ARCHDALE NC
27263-2758
US

V. Phone/Fax

Practice location:
  • Phone: 336-875-5917
  • Fax: 336-875-5919
Mailing address:
  • Phone: 336-875-5917
  • Fax: 336-875-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number600
License Number StateNC

VIII. Authorized Official

Name: DR. N'TUMA MONDAY JAH
Title or Position: PODIATRIST
Credential: DPM
Phone: 336-875-5917