Provider Demographics
NPI:1700977378
Name:FAMILY FOOT CARE CENTER
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAWTHON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:731-660-3664
Mailing Address - Street 1:2033 GREYSTONE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-660-3664
Mailing Address - Fax:731-660-3620
Practice Address - Street 1:2033 GREYSTONE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-660-3664
Practice Address - Fax:731-660-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN529TN213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1266950001Medicare NSC