Healthcare Provider Details

I. General information

NPI: 1073750683
Provider Name (Legal Business Name): JOE K ADES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 JOE KNOX AVENUE SUITE 100
MOORESVILLE NC
28117
US

IV. Provider business mailing address

143 JOE KNOX AVENUE SUITE 100
MOORESVILLE NC
28117
US

V. Phone/Fax

Practice location:
  • Phone: 704-662-3660
  • Fax: 704-662-3595
Mailing address:
  • Phone: 704-662-3660
  • Fax: 704-662-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number697
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number524
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: