Provider Demographics
NPI:1962993147
Name:FRIENDLY FOOT CENTERS, PLLC
Entity type:Organization
Organization Name:FRIENDLY FOOT CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PETERY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-339-2007
Mailing Address - Street 1:5921 W FRIENDLY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3268
Mailing Address - Country:US
Mailing Address - Phone:336-218-8490
Mailing Address - Fax:760-345-3609
Practice Address - Street 1:5921 W FRIENDLY AVE STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3268
Practice Address - Country:US
Practice Address - Phone:336-218-8490
Practice Address - Fax:336-299-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC409213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1962993147Medicaid