Provider Demographics
NPI:1942387865
Name:ANDERSON FOOT CLINIC
Entity Type:Organization
Organization Name:ANDERSON FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:864-224-1836
Mailing Address - Street 1:408 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-224-1836
Mailing Address - Fax:864-224-1802
Practice Address - Street 1:408 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-224-1836
Practice Address - Fax:864-224-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC065213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
20043215OtherSELECT HEALTH
SCDE1962Medicaid
SCGP9991Medicaid
=========OtherEIN
20043215OtherSELECT HEALTH
T24382Medicare UPIN
SCDE1962Medicaid