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General NPI Number Information
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NPI Number | 1396138228
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Entity Type | Organization
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Legal Business Name | BARNABAS PODIATRY & HEALTH WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 2709 SOUTHERN TRACE DR
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City | WAXHAW
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State | NC
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Zip | 28173-0010
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Country | US
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Telephone | 704-905-7905
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Fax |
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Provider Business Mailing Address
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Address Line | 2709 SOUTHERN TRACE DR
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City | WAXHAW
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State | NC
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Zip | 28173-0010
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Country | US
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Telephone | 704-905-7905
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BARBARA WORLEY
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Credential | DPM
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Telephone | 704-905-7905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 642
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License Number State | SC
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