Provider Demographics
NPI:1073797908
Name:ANKLE & FOOT SPECIALIST
Entity Type:Organization
Organization Name:ANKLE & FOOT SPECIALIST
Other - Org Name:E RICHARD GROVES DPM PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:E. RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:229-226-1338
Mailing Address - Street 1:800 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6611
Mailing Address - Country:US
Mailing Address - Phone:229-226-1338
Mailing Address - Fax:229-226-4888
Practice Address - Street 1:800 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6611
Practice Address - Country:US
Practice Address - Phone:229-226-1338
Practice Address - Fax:229-226-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPO 551213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0509810001Medicare NSC