Healthcare Provider Details

I. General information

NPI: 1104871318
Provider Name (Legal Business Name): JOHN T MCCORMICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 MORGANTON BLVD SW
LENOIR NC
28645-5605
US

IV. Provider business mailing address

1041 MORGANTON BLVD SW SUITE 200
LENOIR NC
28645-5605
US

V. Phone/Fax

Practice location:
  • Phone: 828-758-8559
  • Fax: 828-330-2038
Mailing address:
  • Phone: 828-758-8559
  • Fax: 828-294-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20048
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: