Provider Demographics
NPI:1710002241
Name:PERSONAL FOOT & ANKLE SPECIALIST,PC
Entity Type:Organization
Organization Name:PERSONAL FOOT & ANKLE SPECIALIST,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THUY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-552-1086
Mailing Address - Street 1:PO BOX 5969
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-5969
Mailing Address - Country:US
Mailing Address - Phone:478-552-1086
Mailing Address - Fax:478-552-6333
Practice Address - Street 1:1820 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2300
Practice Address - Country:US
Practice Address - Phone:478-552-1086
Practice Address - Fax:478-552-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000790213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00723907BMedicaid
GA00723907BMedicaid
GA48SCCHSMedicare ID - Type UnspecifiedGA MEDICARE