Organization
PIEDMONT ENDOCRINOLOGY MEDICAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GODWIN OBI UZOMBA M.D. (PRESIDENT)
(704) 540-9181
Entity
Organization
Contact information
Practice address
430 S HERLONG AVE, SUITE 106, ROCK HILL, SC 29732-9446
(803) 366-1984
Mailing address
430 S HERLONG AVE, SUITE 106, ROCK HILL, SC 29732-9446
(803) 366-1984
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
200000152
NC
173000000X
Legal Medicine
23415
SC
174400000X
Specialist
23415
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1763
—
SC
01
—
GP3653
MEDICAID
SC
Enumeration date
05/20/2008
Last updated
05/20/2008
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