Provider Demographics
NPI:1588858922
Name:WEBB'S FOOT AND WOUND CARE CLINIC, LLC
Entity Type:Organization
Organization Name:WEBB'S FOOT AND WOUND CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LATASHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:229-588-6843
Mailing Address - Street 1:2907 WATSON BLVD STE I
Mailing Address - Street 2:#184
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8513
Mailing Address - Country:US
Mailing Address - Phone:229-588-6843
Mailing Address - Fax:866-843-2717
Practice Address - Street 1:2907 WATSON BLVD STE I
Practice Address - Street 2:#184
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8513
Practice Address - Country:US
Practice Address - Phone:229-588-6843
Practice Address - Fax:866-843-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2353013-NO261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G704470Medicare PIN