Provider Demographics
NPI:1902836885
Name:CAHABA PODIATRY, INC.
Entity Type:Organization
Organization Name:CAHABA PODIATRY, INC.
Other - Org Name:PELL CITY PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:D
Authorized Official - Last Name:YEAGER-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-980-2005
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-0273
Mailing Address - Country:US
Mailing Address - Phone:205-980-2005
Mailing Address - Fax:205-980-6889
Practice Address - Street 1:5511 HIGHWAY 280
Practice Address - Street 2:SUITE 124
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6585
Practice Address - Country:US
Practice Address - Phone:205-980-2005
Practice Address - Fax:205-980-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL161213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51046369OtherBCBS PROVIDER NUMBER
AL000046369Medicare ID - Type UnspecifiedPROVIDER NUMBER
AL1290830002Medicare NSC