Provider Demographics
NPI:1710064233
Name:DIABETES ENDOCRINOLOGY & METABOLISM ASSOCIATES, PA
Entity Type:Organization
Organization Name:DIABETES ENDOCRINOLOGY & METABOLISM 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:OBINNA
Authorized Official - Last Name:UZOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-540-9181
Mailing Address - Street 1:PO BOX 471947
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-1947
Mailing Address - Country:US
Mailing Address - Phone:704-540-9181
Mailing Address - Fax:704-540-9182
Practice Address - Street 1:115 STONE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6489
Practice Address - Country:US
Practice Address - Phone:704-540-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3653Medicaid
SCGP1763Medicaid
NC014KKOtherBC/BS OF NORTH CAROLINA
NC891277FMedicaid
NC89014KKMedicaid
SC1710064233OtherGROUP NPI
NC1710064233OtherGROUP NPI
NC89014KKMedicaid
SCGP3653Medicaid
SC1710064233OtherGROUP NPI
SCGP1763Medicaid
SC7673Medicare PIN