Healthcare Provider Details

I. General information

NPI: 1417919390
Provider Name (Legal Business Name): FAYETTEVILLE ORTHOPAEDIC CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 FORDHAM DR SUITE 100
FAYETTEVILLE NC
28304-3650
US

IV. Provider business mailing address

1991 FORDHAM DRIVE STE 100
FAYETTEVILLE NC
28304
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-3114
  • Fax: 910-484-8824
Mailing address:
  • Phone: 910-484-3114
  • Fax: 910-484-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: JAMES ERWIN JOHNSON
Title or Position: PRACTICE ADMINISTRATOR
Credential: M.D.
Phone: 910-223-2007