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General NPI Number Information
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NPI Number | 1558499046
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Entity Type | Organization
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Legal Business Name | AAA FAMILY FOOT CARE CENTER,PLLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 9124 S TRYON ST SUITE J
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City | CHARLOTTE
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State | NC
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Zip | 28273-3114
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Country | US
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Telephone | 704-588-7373
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Fax | 704-588-7585
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Provider Business Mailing Address
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Address Line | 9124 S TRYON ST SUITE J
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City | CHARLOTTE
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State | NC
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Zip | 28273-3114
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Country | US
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Telephone | 704-588-7373
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Fax | 704-588-7585
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Authorized Official
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Title or Position | PYHSICIAN
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Name | DR. JOHN LONGOBARDO
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Credential | D.P.M.,M.D.
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Telephone | 704-588-7373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 320
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License Number State | NC
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