Provider Demographics
NPI:1083897730
Name:MORRISTOWN FOOT CLINIC, PC
Entity Type:Organization
Organization Name:MORRISTOWN FOOT CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-581-9070
Mailing Address - Street 1:1457 W MORRIS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2828
Mailing Address - Country:US
Mailing Address - Phone:423-581-9070
Mailing Address - Fax:423-581-9303
Practice Address - Street 1:1457 W MORRIS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2828
Practice Address - Country:US
Practice Address - Phone:423-581-9070
Practice Address - Fax:423-581-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM440213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1083897730OtherMEDICARE DME LOCATION
TN3352198Medicaid
GA480027658OtherMEDICARE RAILROAD RETIREMENT
TNU41595Medicare UPIN
TN4435300001Medicare NSC
TN3352198Medicare PIN