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SOUTHERN PODIATRY FOOT AND ANKLE LLC NPI 1619112968


NPI Information

NPI: 1619112968
Provider Name: SOUTHERN PODIATRY FOOT AND ANKLE LLC
Classification: Podiatrist - 213E00000X
Entity Type: Organization
Address:
212 LAKE PEHAMA TRAIL
HOMER, GA
ZIP 30547
Phone: (312) 752-7713
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SOUTHERN PODIATRY FOOT AND ANKLE LLC is a podiatrist in Homer, GA. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. SOUTHERN PODIATRY FOOT AND ANKLE LLC NPI is 1619112968. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

212 LAKE PEHAMA TRAIL
HOMER, GA
ZIP 30547
Phone: (312) 752-7713

The provider's authorized official is Rick Thornton .
The authorized official title is Owner and has the following contact phone number (312) 752-7713.

The enumeration date for this NPI number is 12/15/2008 and was last updated on 12/15/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213E00000XPodiatrist5981134TENNESSEEYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1111480025MEDICARE PINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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