Healthcare Provider Details

I. General information

NPI: 1558499046
Provider Name (Legal Business Name): AAA FAMILY FOOT CARE CENTER,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9124 S TRYON ST SUITE J
CHARLOTTE NC
28273-3114
US

IV. Provider business mailing address

9124 S TRYON ST SUITE J
CHARLOTTE NC
28273-3114
US

V. Phone/Fax

Practice location:
  • Phone: 704-588-7373
  • Fax: 704-588-7585
Mailing address:
  • Phone: 704-588-7373
  • Fax: 704-588-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number320
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN LONGOBARDO
Title or Position: PYHSICIAN
Credential: D.P.M.,M.D.
Phone: 704-588-7373