Healthcare Provider Details

I. General information

NPI: 1902596448
Provider Name (Legal Business Name): PREMIER FOOT & ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 W HIGHWAY 74 STE K
MONROE NC
28110-8695
US

IV. Provider business mailing address

PO BOX 25
MARSHVILLE NC
28103-0025
US

V. Phone/Fax

Practice location:
  • Phone: 704-624-7090
  • Fax: 704-624-7029
Mailing address:
  • Phone: 704-624-7090
  • Fax: 704-624-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SHALANDA HALL
Title or Position: OWNER
Credential:
Phone: 704-624-7090