Provider Demographics
NPI:1720139710
Name:THE FOOT AND ANKLE GROUP PC
Entity Type:Organization
Organization Name:THE FOOT AND ANKLE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KILE
Authorized Official - Middle Name:WOODROW
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-724-0586
Mailing Address - Street 1:1515 LANEY WALKER BLVD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5827
Mailing Address - Country:US
Mailing Address - Phone:706-724-0586
Mailing Address - Fax:706-724-4468
Practice Address - Street 1:1515 LANEY WALKER BLVD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5827
Practice Address - Country:US
Practice Address - Phone:706-724-0586
Practice Address - Fax:706-724-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGRP2839213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X
GA1196250004332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300032875AMedicaid
GA300032875AMedicaid
GA300032875AMedicaid
1196250004Medicare NSC
GAGRP2839Medicare PIN
GA=========OtherTAX ID NUMBER
GAT97767Medicare UPIN
GAT97692Medicare UPIN
GAT97703Medicare UPIN