Provider Demographics
NPI:1558578237
Name:GREATER ALABAMA FAMILY FOOT CARE, LLC
Entity Type:Organization
Organization Name:GREATER ALABAMA FAMILY FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONA
Authorized Official - Middle Name:RENELL
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-863-2530
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863-1026
Mailing Address - Country:US
Mailing Address - Phone:334-863-2530
Mailing Address - Fax:334-642-3669
Practice Address - Street 1:469 PRICE ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-2104
Practice Address - Country:US
Practice Address - Phone:334-863-2530
Practice Address - Fax:334-642-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL193261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51510661OtherAL BCBS NUMBER
AL193OtherAL STATE LIC. NUMBER
AL5407030001OtherAL DEMERC NUMBER
AL193OtherAL STATE LIC. NUMBER
AL=========OtherAL TAX ID NUMBER
AL5407030001OtherAL DEMERC NUMBER