Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 02948 | GA |
Y | 222Z00000X | Podiatrist | 02948 | GA |
N | 224P00000X | Prosthetist | 02948 | GA |
NPI | 1386204923 |
---|---|
Provider Name | Berry Dewayne Aycock |
First Address | Pinehurst, NC 28374-4754 |
Second Address | Pinehurst, NC 28374-0088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 17/06/2019 |