Healthcare Provider Details

I. General information

NPI: 1033202957
Provider Name (Legal Business Name): FOOT CENTERS OF NC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 HEALY DR STE B
WINSTON SALEM NC
27103-1569
US

IV. Provider business mailing address

76764 LANCELOT CT
PALM DESERT CA
92211-7103
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-8848
  • Fax: 336-768-3078
Mailing address:
  • Phone: 760-408-5053
  • Fax: 760-345-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number297
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number297
License Number StateNC

VIII. Authorized Official

Name: JOHN ANDREW PETERY
Title or Position: PRESIDENT
Credential: DPM
Phone: 336-218-8490