Basic Information
| Provider Information | |||||||||
| NPI: | 1134573439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN A AZZATO MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11505 | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284611505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104548030 | ||||||||
| FaxNumber: | 9103634828 | ||||||||
| Practice Location | |||||||||
| Address1: | 1503 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286254301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048719731 | ||||||||
| FaxNumber: | 7048711105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2016 | ||||||||
| LastUpdateDate: | 04/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | AZZATO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9104548030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.