Azalea Coast Podiatry and Foot Spa, PLLC

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

509 Issued in NC

Legal business name

AZALEA COAST PODIATRY AND FOOT SPA, PLLC

Practice address

1604 Physicians Dr
Suite 105
Wilmington, NC 28401-7362

Phone

(910) 777-9054

Fax

(910) 256-6039

NPI assigned

Jan 6, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kerry Allyson Smith, DPMNPI 1598834350

Title

Member/Manager

Phone

(910) 777-9054

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kerry Allyson Smith, DPM

  • Foot Surgery Podiatrist
  • Wilmington, NC
  • NPI 1598834350
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1760870323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 PHYSICIANS DR",
            "address_2": "SUITE 105",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017362",
            "telephone_number": "910-777-9054",
            "fax_number": "910-256-6039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 PHYSICIANS DR",
            "address_2": "SUITE 105",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017362",
            "telephone_number": "910-777-9054",
            "fax_number": "910-256-6039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZALEA COAST PODIATRY AND FOOT SPA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-06",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "ALLYSON",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "910-777-9054",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NC",
            "license": "509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Azalea Gynecology PA
• Azalea Primary Care
• Ghobad Azizi, M.D.

• Foot Surgery Podiatrist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Foot Surgery Podiatrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.