Provider Demographics
NPI:1407032337
Name:FAMILY FOOT CARE CENTER
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CENTER
Other - Org Name:JON T. MIDDLETON, DPM, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-335-4884
Mailing Address - Street 1:679 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1146
Mailing Address - Country:US
Mailing Address - Phone:706-335-4884
Mailing Address - Fax:706-336-8798
Practice Address - Street 1:679 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1146
Practice Address - Country:US
Practice Address - Phone:706-335-4884
Practice Address - Fax:706-336-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00865103AMedicaid
GA00865103AMedicaid
GAU71902Medicare UPIN
GA4754730001Medicare NSC