Healthcare Provider Details

I. General information

NPI: 1811914435
Provider Name (Legal Business Name): JOHN A AZZATO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 N HOWE ST STE 4
SOUTHPORT NC
28461-2770
US

IV. Provider business mailing address

PO BOX 11515
SOUTHPORT NC
28461-1515
US

V. Phone/Fax

Practice location:
  • Phone: 910-805-5578
  • Fax:
Mailing address:
  • Phone: 910-454-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number20698
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20698
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number20698
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20698
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: