Organization
JOHNNIE NINE TOES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN G PIACENTI DPM (PRES)
(757) 418-5668
Entity
Organization
Contact information
Practice address
1416 SHENANDOAH PKWY, CHESAPEAKE, VA 23320-8137
(757) 418-4556
(757) 549-2004
Mailing address
1416 SHENANDOAH PKWY, CHESAPEAKE, VA 23320-8137
(757) 418-4556
(757) 549-2004
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180924
BLUE CROSS BLUE SHEILD
VA
Enumeration date
08/08/2007
Last updated
09/19/2007
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