Provider Demographics
NPI:1336466341
Name:FOOT & ANKLE INSTITUTE OF SOUTH GEORGIA PC
Entity Type:Organization
Organization Name:FOOT & ANKLE INSTITUTE OF SOUTH GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:SWORDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-444-6334
Mailing Address - Street 1:4370 KINGS WAY STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6905
Mailing Address - Country:US
Mailing Address - Phone:229-244-0070
Mailing Address - Fax:229-244-0080
Practice Address - Street 1:4370 KINGS WAY STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6905
Practice Address - Country:US
Practice Address - Phone:229-244-0070
Practice Address - Fax:229-244-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA982802481AMedicaid
GA6446640001Medicare NSC
202G708146Medicare PIN