Provider Demographics
NPI:1285819714
Name:EMANUEL FOOT & ANKLE ASSOC
Entity Type:Organization
Organization Name:EMANUEL FOOT & ANKLE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-237-8844
Mailing Address - Street 1:120B VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3235
Mailing Address - Country:US
Mailing Address - Phone:478-237-8844
Mailing Address - Fax:478-237-8887
Practice Address - Street 1:120B VICTORY DR
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3235
Practice Address - Country:US
Practice Address - Phone:478-237-8844
Practice Address - Fax:478-237-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000649213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA341274OtherWELLCARE
GA341274OtherWELLCARE
GA48SCCPXMedicare PIN