Provider Demographics
NPI:1164797221
Name:LAFAYETTE FOOT & LEG SPECIALIST PC
Entity Type:Organization
Organization Name:LAFAYETTE FOOT & LEG SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRISTS-D.P.M.
Authorized Official - Prefix:DR
Authorized Official - First Name:HOANG
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFAYETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-436-3056
Mailing Address - Street 1:2600 W DOUBLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9234
Mailing Address - Country:US
Mailing Address - Phone:229-436-3056
Mailing Address - Fax:226-436-3056
Practice Address - Street 1:2600 W DOUBLEGATE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-9234
Practice Address - Country:US
Practice Address - Phone:229-436-3056
Practice Address - Fax:229-346-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000760213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty