Provider Demographics
NPI:1780725127
Name:THE GA FOOT AND ANKLE INST PC
Entity type:Organization
Organization Name:THE GA FOOT AND ANKLE INST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:912-355-6503
Mailing Address - Street 1:310 EISENHOWER DR
Mailing Address - Street 2:BLDG 7A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-355-6503
Mailing Address - Fax:912-355-9837
Practice Address - Street 1:310 EISENHOWER DR
Practice Address - Street 2:BLDG 7A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-355-6503
Practice Address - Fax:912-355-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA973213ES0103X
GA885213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000880514AMedicaid
GA897396002AMedicaid
GA000880514AMedicaid
GAU81274Medicare UPIN
GAGRP 374Medicare PIN
GA0634000002Medicare NSC