Organization
DIABETES ENDOCRINOLOGY & METABOLISM ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GODWIN OBINNA UZOMBA M.D. (PRESIDENT)
(704) 540-9181
Entity
Organization
Contact information
Practice address
115 STONE VILLAGE DR, FORT MILL, SC 29708-6489
(704) 540-9181
Mailing address
PO BOX 471947, CHARLOTTE, NC 28247-1947
(704) 540-9181
(704) 540-9182
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014KK
BC/BS OF NORTH CAROLINA
NC
01
—
1710064233
GROUP NPI
NC
01
—
1710064233
GROUP NPI
SC
05
—
89014KK
—
NC
05
—
891277F
—
NC
05
—
GP1763
—
SC
05
—
GP3653
—
SC
Enumeration date
11/01/2006
Last updated
07/21/2022
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