MEDICARE: FOOT AND ANKLE ASSOCIATES OF NC, PLLC

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1518452143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE ASSOCIATES OF NC, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 14759
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27620-4759
Country	:	US
Telephone Number	:	919-231-7969
Fax Number	:	919-231-7970

Provider Business Practice Location Address
First Line	:	2130 FOREST HILLS RD W STE C
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3681
Country	:	US
Telephone Number	:	252-281-4442
Fax Number	:	252-281-4439

Authorized Official
Title or Position	:	PARTNER/OWNER
Name	:	CLARENCE M STEWART
Credential	:	DPM
Telephone Number	:	919-231-7969

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	03/14/2022

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