Provider Demographics
NPI:1043577281
Name:ATLANTIC COAST FOOT AND ANKLE CARE
Entity Type:Organization
Organization Name:ATLANTIC COAST FOOT AND ANKLE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-604-1733
Mailing Address - Street 1:204 GRANDVILLE ARCH
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-6150
Mailing Address - Country:US
Mailing Address - Phone:757-604-1733
Mailing Address - Fax:757-337-4024
Practice Address - Street 1:204 GRANDVILLE ARCH
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-6150
Practice Address - Country:US
Practice Address - Phone:757-604-1733
Practice Address - Fax:757-337-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001007213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty