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General NPI Number Information
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NPI Number | 1871524595
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Entity Type | Organization
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Legal Business Name | CHARLOTTE FOOT CLINIC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 4016 WILKINSON BLVD STE A
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City | CHARLOTTE
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State | NC
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Zip | 28208
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Country | US
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Telephone | 704-394-4980
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Fax | 704-392-8962
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Provider Business Mailing Address
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Address Line | 4016 WILKINSON BLVD STE A
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City | CHARLOTTE
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State | NC
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Zip | 28208
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Country | US
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Telephone | 704-394-4980
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Fax | 704-392-8962
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Authorized Official
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Title or Position | MOA INSURANCE PROCESSOR
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Name | MS. NANCY A TROUTMAN
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Credential | MOA
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Telephone | 704-394-4980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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