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General NPI Number Information
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NPI Number | 1013025212
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Entity Type | Organization
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Legal Business Name | PIEDMONT JOINT REPLACEMENT, BACK & SPORTS MEDICINE CENTER, PLLC
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 09/02/2008
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Provider Practice Location Address
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Address Line | 110 S PARK TER
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City | EDEN
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State | NC
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Zip | 27288-5351
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Country | US
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Telephone | 336-623-2623
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Fax | 336-623-7909
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Provider Business Mailing Address
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Address Line | 110 S PARK TER
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City | EDEN
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State | NC
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Zip | 27288-5351
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Country | US
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Telephone | 336-623-2623
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Fax | 336-623-7909
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TITUS PLOMARITIS JR.
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Credential | MD
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Telephone | 336-623-2623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 31615
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License Number State | NC
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