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NPI Code Detail

MEDICARE: SUNBELT FAMILY FOOTCARE SPECIALISTS

MEDICARE: SUNBELT FAMILY FOOTCARE SPECIALISTS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery PodiatristOH

General Provider Information

NPI Number : 1265597496
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNBELT FAMILY FOOTCARE SPECIALISTS
Provider Business Mailing Address
First Line : PO BOX 668093
Second Line :
City : CHARLOTTE
State : NC
Zip : 28266-8093
Country : US
Telephone Number : 704-737-6126
Fax Number :
Provider Business Practice Location Address
First Line : 3333 WILKINSON BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-5631
Country : US
Telephone Number : 704-737-6126
Fax Number :
Authorized Official
Title or Position : DOCTOR OF PODIATRIC MEDICINE
Name : DR. REGINALD BARNETTE RICHARDSON III
Credential :
Telephone Number : 704-733-7101
Provider Enumeration Date : 12/27/2006
Last Update Date : 09/09/2008

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