Provider Demographics
NPI:1386152247
Name:TOWN CENTER PODIATRY, PLLC
Entity type:Organization
Organization Name:TOWN CENTER PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:N'TUMA
Authorized Official - Middle Name:MONDAY
Authorized Official - Last Name:JAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-875-5917
Mailing Address - Street 1:140 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-2758
Mailing Address - Country:US
Mailing Address - Phone:336-875-5917
Mailing Address - Fax:336-875-5919
Practice Address - Street 1:140 BAKER RD
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263
Practice Address - Country:US
Practice Address - Phone:336-875-5917
Practice Address - Fax:336-875-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty