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General NPI Number Information
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NPI Number | 1134573439
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Entity Type | Organization
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Legal Business Name | JOHN A AZZATO MD PC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 1503 E BROAD ST
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City | STATESVILLE
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State | NC
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Zip | 28625-4301
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Country | US
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Telephone | 704-871-9731
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Fax | 704-871-1105
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Provider Business Mailing Address
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Address Line | PO BOX 11505
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City | SOUTHPORT
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State | NC
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Zip | 28461-1505
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Country | US
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Telephone | 910-454-8030
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Fax | 910-363-4828
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Authorized Official
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Title or Position | OWNER
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Name | JOHN A AZZATO
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Credential | MD
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Telephone | 910-454-8030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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