Provider Demographics
NPI:1598010720
Name:SWGA FOOT & ANKLE CENTER
Entity Type:Organization
Organization Name:SWGA FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:229-928-6000
Mailing Address - Street 1:PO BOX 7033
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-7033
Mailing Address - Country:US
Mailing Address - Phone:229-928-6000
Mailing Address - Fax:229-928-6369
Practice Address - Street 1:415 E 4TH AVE STE B
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-0614
Practice Address - Country:US
Practice Address - Phone:229-273-0140
Practice Address - Fax:229-273-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000807213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty