Provider Demographics
NPI:1265570691
Name:SKALLA, CRAIG KEVIN (DPM)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:KEVIN
Last Name:SKALLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-303-3552
Mailing Address - Fax:912-303-3506
Practice Address - Street 1:1326 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-691-4100
Practice Address - Fax:912-691-4289
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA694213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000591093BMedicaid
GA000591093BMedicaid
GA202I481929Medicare PIN