Active NPI
Fayetteville Foot and Ankle Center
- Foot & Ankle Surgery Podiatrist
- Fayetteville, NC
National Provider Identifier
1821132424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 240
- Legal business name
- FAYETTEVILLE FOOT AND ANKLE CENTER
- Practice address
- 503 Owen Dr
Fayetteville, NC 28304-3433 - Phone
- (910) 483-3338
- Fax
- (910) 483-3386
- NPI assigned
- Feb 16, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. George John Demetri Jr., D.P.M.
- Title
- Doctor
- Phone
- (910) 483-3338
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 240 | NC | Primary |
Addresses
Primary practice location
503 Owen Dr
Fayetteville, NC 28304-3433
Mailing address
503 Owen Dr
Fayetteville, NC 28304-3433
Phone (910) 483-3338
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 890805F | Medicaid | NC | |
| 0153T | Other | NC | BLUE CROSS BLUE SHIELD |
National Provider Directory
National Provider DirectoryLocations
503 Owen Dr
Fayetteville, NC 28304
Phone (910) 483-3338
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1300752000000",
"number": "1821132424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 OWEN DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043433",
"telephone_number": "910-483-3338",
"fax_number": "910-483-3386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 OWEN DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043433",
"telephone_number": "910-483-3338",
"fax_number": "910-483-3386"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAYETTEVILLE FOOT AND ANKLE CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-16",
"last_updated": "2011-03-22",
"status": "A",
"authorized_official_last_name": "DEMETRI",
"authorized_official_first_name": "GEORGE",
"authorized_official_middle_name": "JOHN",
"authorized_official_title_or_position": "DOCTOR",
"authorized_official_telephone_number": "910-483-3338",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "D.P.M."
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "NC",
"license": "240",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "890805F",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0153T",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
- Fayetteville Endocrinology and Diabetes Clinic PA
- Fayetteville Family Extended Care
- Fayetteville Family Medical Care, PA
- Fayetteville Family Medical Care, PA (Fayetteville Family Pharmacy)
- Fayetteville Fingerprinting & Diagnostics, LLC
- Fayetteville Gastroenterology Associates, P.a.
- Fayetteville Gastroenterology Associates, P.a.
- Fayetteville Gastroenterology Endoscopy Center, LLC
- Fayetteville Geriatric & Internal Medicine Clinic PA
- Fayetteville Heart Center, P.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.