1780725127 NPI number — THE GA FOOT AND ANKLE INST PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780725127 NPI number — THE GA FOOT AND ANKLE INST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GA FOOT AND ANKLE INST PC
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:
1780725127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 EISENHOWER DR
Provider Second Line Business Mailing Address:
BLDG 7A
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31406-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-355-6503
Provider Business Mailing Address Fax Number:
912-355-9837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 EISENHOWER DR
Provider Second Line Business Practice Location Address:
BLDG 7A
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31406-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-355-6503
Provider Business Practice Location Address Fax Number:
912-355-9837
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROUSE
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
912-355-6503

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  973 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 885 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000880514A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 897396002A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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