Provider Demographics
NPI:1962841460
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:980-299-0223
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:980-299-0023
Mailing Address - Fax:980-299-1002
Practice Address - Street 1:4456 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5702
Practice Address - Country:US
Practice Address - Phone:980-299-0023
Practice Address - Fax:980-299-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RE0101X
SC23415305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty