Provider Demographics
NPI:1346278629
Name:JOHNCOCK, WILLIAM JESSE (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JESSE
Last Name:JOHNCOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:36 14TH AVE NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2581
Mailing Address - Country:US
Mailing Address - Phone:828-327-3029
Mailing Address - Fax:828-327-3181
Practice Address - Street 1:36 14TH AVE NE
Practice Address - Street 2:SUITE 102
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2581
Practice Address - Country:US
Practice Address - Phone:828-327-3029
Practice Address - Fax:828-327-3181
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC348213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890808 NMedicaid
NC0808 NOtherBLUE CROSS BLUE SHIELDNC
NC2432504 AMedicare ID - Type Unspecified
NCU44957Medicare UPIN