Provider Demographics
NPI:1104218544
Name:GA FOOT AND ANKLE INSTITUTE
Entity Type:Organization
Organization Name:GA FOOT AND ANKLE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-355-6503
Mailing Address - Street 1:310 EISENHOWER DR
Mailing Address - Street 2:BUILDING 7A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-355-6503
Mailing Address - Fax:912-355-9837
Practice Address - Street 1:119 CANAL ST
Practice Address - Street 2:SUITE 106
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4095
Practice Address - Country:US
Practice Address - Phone:912-355-6503
Practice Address - Fax:912-355-9837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GA FOOT AND ANKLE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA885213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000880514Medicaid
GAU95769Medicare UPIN
GA000880514Medicaid
GA0634000002Medicare NSC