Provider Demographics
NPI:1689820938
Name:SOUTHWEST PODIATRY, P.C.
Entity Type:Organization
Organization Name:SOUTHWEST PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-228-2212
Mailing Address - Street 1:2851 CARROLLTON PIKE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3668
Mailing Address - Country:US
Mailing Address - Phone:276-236-9663
Mailing Address - Fax:276-236-8909
Practice Address - Street 1:2851 CARROLLTON PIKE
Practice Address - Street 2:SUITE A3
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3668
Practice Address - Country:US
Practice Address - Phone:276-236-9663
Practice Address - Fax:276-236-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000769213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty