Provider Demographics
NPI:1720533672
Name:FOOT SPECIALISTS OF ALABAMA LLC
Entity Type:Organization
Organization Name:FOOT SPECIALISTS OF ALABAMA LLC
Other - Org Name:MARSHALL FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:DP,M
Authorized Official - Phone:208-604-3387
Mailing Address - Street 1:7633 AL HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7137
Mailing Address - Country:US
Mailing Address - Phone:256-571-8750
Mailing Address - Fax:256-571-8767
Practice Address - Street 1:7633 AL HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7137
Practice Address - Country:US
Practice Address - Phone:256-571-8750
Practice Address - Fax:256-571-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-21
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL327213E00000X, 213ES0103X
AL261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty