Provider Demographics
NPI:1669640959
Name:DOUGLASVILLE FS INC
Entity Type:Organization
Organization Name:DOUGLASVILLE FS INC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-577-3677
Mailing Address - Street 1:9503 HIGHWAY 5
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1515
Mailing Address - Country:US
Mailing Address - Phone:770-577-3677
Mailing Address - Fax:770-577-3627
Practice Address - Street 1:9503 HIGHWAY 5
Practice Address - Street 2:SUITE 104
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1515
Practice Address - Country:US
Practice Address - Phone:770-577-3677
Practice Address - Fax:770-577-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5523860001Medicare NSC