1093985889 NPI number — PARKWOOD PODIATRY ASSOCIATES, LLC

Table of content: (NPI 1093985889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093985889 NPI number — PARKWOOD PODIATRY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKWOOD PODIATRY ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093985889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 STARLING ST
Provider Second Line Business Mailing Address:
STE 301
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31520-4268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-265-4766
Provider Business Mailing Address Fax Number:
912-267-9857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E OGLETHORPE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31313-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-368-3036
Provider Business Practice Location Address Fax Number:
912-368-3526
Provider Enumeration Date:
03/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
912-265-4766

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)