Provider Demographics
NPI:1609033356
Name:PIEDMONT ENDOCRINOLOGY MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:PIEDMONT ENDOCRINOLOGY MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:OBI
Authorized Official - Last Name:UZOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-540-9181
Mailing Address - Street 1:430 S HERLONG AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9446
Mailing Address - Country:US
Mailing Address - Phone:803-366-1984
Mailing Address - Fax:
Practice Address - Street 1:430 S HERLONG AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9446
Practice Address - Country:US
Practice Address - Phone:803-366-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23415173000000X, 174400000X
NC200000152173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3653OtherMEDICAID
SCGP1763Medicaid
SCH07556Medicare UPIN
SCGP1763Medicaid