Provider Demographics
NPI:1043849334
Name:BIELA, GARRETT (DPM)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:BIELA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 JOE KNOX AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9244
Mailing Address - Country:US
Mailing Address - Phone:704-662-3660
Mailing Address - Fax:704-662-3595
Practice Address - Street 1:143 JOE KNOX AVE STE 100
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9244
Practice Address - Country:US
Practice Address - Phone:704-662-3660
Practice Address - Fax:704-662-3595
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC814213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program