Provider Demographics
NPI:1821277591
Name:ALBANY PODIATRY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:ALBANY PODIATRY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:229-883-3535
Mailing Address - Street 1:531 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1921
Mailing Address - Country:US
Mailing Address - Phone:229-883-3535
Mailing Address - Fax:229-883-3783
Practice Address - Street 1:531 7TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1921
Practice Address - Country:US
Practice Address - Phone:229-883-3535
Practice Address - Fax:229-883-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A0463OtherRAILROAD MEDICARE
A0463OtherRAILROAD MEDICARE
GA1296Medicare PIN