Provider Demographics
NPI:1851339899
Name:CENTER FOR DIABETES FOOT CARE
Entity Type:Organization
Organization Name:CENTER FOR DIABETES FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-372-9575
Mailing Address - Street 1:820 COOPER RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-4099
Mailing Address - Country:US
Mailing Address - Phone:601-372-9575
Mailing Address - Fax:601-376-0404
Practice Address - Street 1:820 COOPER RD
Practice Address - Street 2:SUITE I
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-4099
Practice Address - Country:US
Practice Address - Phone:601-372-9575
Practice Address - Fax:601-376-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty