Provider Demographics
NPI:1598865784
Name:SOUTHERN FOOT CARE INC
Entity Type:Organization
Organization Name:SOUTHERN FOOT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:GARBO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-833-4815
Mailing Address - Street 1:427 NORTH JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601
Mailing Address - Country:US
Mailing Address - Phone:601-833-4815
Mailing Address - Fax:601-833-4871
Practice Address - Street 1:427 NORTH JACKSON ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601
Practice Address - Country:US
Practice Address - Phone:601-833-4815
Practice Address - Fax:601-833-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80155213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09586067Medicaid
MS09586067Medicaid