Healthcare Provider Details

I. General information

NPI: 1104905371
Provider Name (Legal Business Name): GUILFORD FOOT CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 TINSLEY DR SUITE 104
HIGH POINT NC
27265-1532
US

IV. Provider business mailing address

3931 TINSLEY DR SUITE 104
HIGH POINT NC
27265-1532
US

V. Phone/Fax

Practice location:
  • Phone: 336-282-8787
  • Fax: 336-510-7284
Mailing address:
  • Phone: 336-282-8787
  • Fax: 336-510-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberNC233
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number233
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number233
License Number StateNC

VIII. Authorized Official

Name: DR. MYEONG SHEARD
Title or Position: PRESIDENT
Credential: DPM
Phone: 336-282-8787