=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619150992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CAROLINA FOOT AND ANKLE CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2007
-----------------------------------------------------
Last Update Date | 01/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 VILLAGE CT
-----------------------------------------------------
City | GARNER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27529-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-661-4150
-----------------------------------------------------
Fax | 919-779-8708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 VILLAGE CT
-----------------------------------------------------
City | GARNER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27529-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-661-4150
-----------------------------------------------------
Fax | 919-779-8708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHUKWUMA UKATA
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 919-906-2057
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 487
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------