# GR VITO-BROOKDALE FOOT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750792867
- **Authorized official:** GEORGE VITO (SOLE MEMBER)
- **Authorized official phone:** (336) 618-6961

## Contact information

- **Practice address:** 533 BROOKDALE DR, STATESVILLE, NC 28677-4107
- **Practice address phone:** (336) 618-6961
- **Mailing address:** PO BOX 24561, WINSTON SALEM, NC 27114-4561
- **Mailing address phone:** (336) 618-6961

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 330 | NC | Yes |

## Other

- **Enumeration date:** 05/12/2014
- **Last updated:** 05/12/2014