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General NPI Number Information
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NPI Number | 1942338538
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Entity Type | Organization
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Legal Business Name | CAROLINA PODIATRY CENTER PLLC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 36 14TH AVE NE SUITE 102
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City | HICKORY
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State | NC
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Zip | 28601-2581
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Country | US
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Telephone | 828-327-3029
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Fax | 828-327-3181
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Provider Business Mailing Address
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Address Line | 36 14TH AVE NE SUITE 102
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City | HICKORY
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State | NC
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Zip | 28601-2581
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Country | US
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Telephone | 828-327-3029
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Fax | 828-327-3181
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. WILLIAM JESSE JOHNCOCK
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Credential | DPM
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Telephone | 828-327-3029
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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 | 348
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License Number State | NC
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