Provider Demographics
NPI:1043494834
Name:BRIAN K. MIDDLETON
Entity Type:Organization
Organization Name:BRIAN K. MIDDLETON
Other - Org Name:MEDICAL FOOT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-802-1800
Mailing Address - Street 1:211 REDMOND RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1537
Mailing Address - Country:US
Mailing Address - Phone:706-802-1800
Mailing Address - Fax:706-802-0781
Practice Address - Street 1:211 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1537
Practice Address - Country:US
Practice Address - Phone:706-802-1800
Practice Address - Fax:706-802-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4692630001Medicare NSC