Provider Demographics
NPI:1760133706
Name:PREMIER FOOT AND ANKLE CARE PC
Entity Type:Organization
Organization Name:PREMIER FOOT AND ANKLE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MALIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-901-0296
Mailing Address - Street 1:1412 TROTWOOD AVE STE 39
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4948
Mailing Address - Country:US
Mailing Address - Phone:931-901-0296
Mailing Address - Fax:931-901-0299
Practice Address - Street 1:1412 TROTWOOD AVE STE 39
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4948
Practice Address - Country:US
Practice Address - Phone:931-505-9169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty