Provider Demographics
NPI:1598240525
Name:INNOVATIVE FOOT AND ANKLE CARE PLLC
Entity Type:Organization
Organization Name:INNOVATIVE FOOT AND ANKLE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:229-548-8481
Mailing Address - Street 1:318 ENGLISH OAK RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8368
Mailing Address - Country:US
Mailing Address - Phone:229-548-8481
Mailing Address - Fax:
Practice Address - Street 1:318 ENGLISH OAK RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8368
Practice Address - Country:US
Practice Address - Phone:229-548-8481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty