Healthcare Provider Details

I. General information

NPI: 1699396572
Provider Name (Legal Business Name): CAROLINA FOOT & ANKLE OF HUNTERSVILLE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 JOE KNOX AVE STE D
MOORESVILLE NC
28117-7912
US

IV. Provider business mailing address

16419 NORTHCROSS DR STE A
HUNTERSVILLE NC
28078-5009
US

V. Phone/Fax

Practice location:
  • Phone: 704-235-0474
  • Fax: 704-660-3987
Mailing address:
  • Phone: 704-987-9585
  • Fax: 704-987-9589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK ALAN QUIST
Title or Position: OWNER
Credential: DPM
Phone: 704-987-9585