MEDICARE: CUTTING EDGE FOOT AND ANKLE CLINIC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	261QP1100X	Podiatric Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106571775	OTHER	TN	DRIVER LICENSE

General Provider Information

NPI Number	:	1154889533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTTING EDGE FOOT AND ANKLE CLINIC, PLLC

Provider Business Mailing Address
First Line	:	1725 HUDSON RD
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115-5705
Country	:	US
Telephone Number	:	615-582-5069
Fax Number	:

Provider Business Practice Location Address
First Line	:	3443 DICKERSON PIKE STE 740
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2527
Country	:	US
Telephone Number	:	615-866-9639
Fax Number	:	615-915-9640

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	YERUSALEM ABEBE LANIER
Credential	:	DPM
Telephone Number	:	615-866-9639

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	01/26/2021

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