Organization
PEACOCK FOOT CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SONYA KING PEACOCK (SECRETARY TREASURER)
(910) 642-7768
Entity
Organization
Contact information
Practice address
325 JEFFERSON ST, WHITEVILLE, NC 28472-3601
(910) 642-7768
(910) 642-6541
Mailing address
325 JEFFERSON ST, WHITEVILLE, NC 28472-3601
(910) 642-7768
(910) 642-6541
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
382
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08003
BCBS NC
NC
05
—
8908003
—
NC
01
—
P00060043
RR MEDICARE
NC
Enumeration date
02/23/2007
Last updated
12/12/2019
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