Individual
JOSEPH C. MAZZOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
310 DAVIE AVE, STATESVILLE, NC 28677-5319
(704) 873-3269
(704) 871-8159
Mailing address
PO BOX 896199, CHARLOTTE, NC 28289-6199
(833) 936-1364
(605) 942-7505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
049190
GA
207Q00000X
Family Medicine Physician
Primary
2010-01894
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00911787E
—
GA
05
—
5916859
—
NC
01
—
NC2409A293
MEDICARE PTAN
NC
Enumeration date
08/02/2006
Last updated
03/09/2021
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