Provider Demographics
NPI:1376043349
Name:GREATER CHARLOTTE FOOT AND ANKLE
Entity Type:Organization
Organization Name:GREATER CHARLOTTE FOOT AND ANKLE
Other - Org Name:CHARLOTTE FOOT CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-228-1350
Mailing Address - Street 1:13425 HOOVER CREEK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-0054
Mailing Address - Country:US
Mailing Address - Phone:704-228-1350
Mailing Address - Fax:
Practice Address - Street 1:13425 HOOVER CREEK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273
Practice Address - Country:US
Practice Address - Phone:704-228-1350
Practice Address - Fax:704-461-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC619213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty