Provider Demographics
NPI:1922272012
Name:FOOT AND ANKLE CENTER OF AUGUSTA
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER OF AUGUSTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-739-0020
Mailing Address - Street 1:1142 DRUID PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5850
Mailing Address - Country:US
Mailing Address - Phone:706-739-0020
Mailing Address - Fax:706-739-0024
Practice Address - Street 1:1142 DRUID PARK AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5850
Practice Address - Country:US
Practice Address - Phone:706-739-0020
Practice Address - Fax:706-739-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000619213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00428975BMedicaid
GA48SCBQRMedicare PIN
GA00428975BMedicaid