Provider Demographics
NPI:1437606407
Name:AFFINITY FOOT AND ANKLE SPECIALISTS LLC
Entity Type:Organization
Organization Name:AFFINITY FOOT AND ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-537-8680
Mailing Address - Street 1:110 HILL POND LN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 HILL POND LN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0872
Practice Address - Country:US
Practice Address - Phone:912-489-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric