Provider Demographics
NPI:1649648569
Name:FEET FIRST PODIATRY, LLC
Entity type:Organization
Organization Name:FEET FIRST PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSUELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS-HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-741-4332
Mailing Address - Street 1:PO BOX 4124
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4124
Mailing Address - Country:US
Mailing Address - Phone:478-741-4332
Mailing Address - Fax:478-741-4343
Practice Address - Street 1:440 CHARTER BLVD STE 2202
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-0705
Practice Address - Country:US
Practice Address - Phone:478-741-4332
Practice Address - Fax:478-741-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000981213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA436532810BMedicaid