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General NPI Number Information
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NPI Number | 1629048566
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Entity Type | Organization
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Legal Business Name | QUEEN CITY FOOT AND ANKLE SPECIALISTS
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 11030 S TRYON ST SUITE 308
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City | CHARLOTTE
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State | NC
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Zip | 28273-6530
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Country | US
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Telephone | 704-504-1004
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Fax | 704-504-0007
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Provider Business Mailing Address
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Address Line | 11030 S TRYON ST SUITE 308
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City | CHARLOTTE
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State | NC
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Zip | 28273-6530
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Country | US
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Telephone | 704-504-1004
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Fax | 704-504-0007
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROXANNE BURGESS
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Credential | D.P.M.
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Telephone | 704-504-1004
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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 | 461
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License Number State | NC
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