Provider Demographics
NPI:1083883151
Name:FOOT AND ANKLE CENTER OF MIDDLE GEORGIA, LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER OF MIDDLE GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARVEPALLI
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOKHAI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-988-4676
Mailing Address - Street 1:PO BOX 6007
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-6007
Mailing Address - Country:US
Mailing Address - Phone:478-929-0036
Mailing Address - Fax:478-929-1744
Practice Address - Street 1:1040 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2904
Practice Address - Country:US
Practice Address - Phone:478-988-4676
Practice Address - Fax:478-987-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000829213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3990060004Medicare NSC