Healthcare Provider Details

I. General information

NPI: 1275002511
Provider Name (Legal Business Name): JUSTIN JAMES FESTA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 MITCHELL AVE
SALISBURY NC
28144-6253
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-216-5633
  • Fax: 704-639-0785
Mailing address:
  • Phone: 610-597-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08471
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: