Provider Demographics
NPI:1235314519
Name:METRO PODIATRY & SPORTS MEDICINE
Entity Type:Organization
Organization Name:METRO PODIATRY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-481-8524
Mailing Address - Street 1:985 9TH AVE SW
Mailing Address - Street 2:SUITE # 405
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4500
Mailing Address - Country:US
Mailing Address - Phone:205-481-8524
Mailing Address - Fax:205-481-8820
Practice Address - Street 1:985 9TH AVE SW
Practice Address - Street 2:SUITE # 405
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4500
Practice Address - Country:US
Practice Address - Phone:205-481-8524
Practice Address - Fax:205-481-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL284213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty