Healthcare Provider Details

I. General information

NPI: 1821132424
Provider Name (Legal Business Name): FAYETTEVILLE FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 OWEN DR
FAYETTEVILLE NC
28304-3433
US

IV. Provider business mailing address

503 OWEN DR
FAYETTEVILLE NC
28304-3433
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-3338
  • Fax: 910-483-3386
Mailing address:
  • Phone: 910-483-3338
  • Fax: 910-483-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number240
License Number StateNC

VIII. Authorized Official

Name: DR. GEORGE JOHN DEMETRI JR.
Title or Position: DOCTOR
Credential: D.P.M.
Phone: 910-483-3338