MEDICARE: WEBB'S FOOT AND WOUND CARE CLINIC, LLC

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	261QP1100X	Podiatric Clinic/Center	2353013-NO	GA

General Provider Information

NPI Number	:	1588858922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBB'S FOOT AND WOUND CARE CLINIC, LLC

Provider Business Mailing Address
First Line	:	2907 WATSON BLVD STE I
Second Line	:	#184
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-8513
Country	:	US
Telephone Number	:	229-588-6843
Fax Number	:	866-843-2717

Provider Business Practice Location Address
First Line	:	2907 WATSON BLVD STE I
Second Line	:	#184
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-8513
Country	:	US
Telephone Number	:	229-588-6843
Fax Number	:	866-843-2717

Authorized Official
Title or Position	:	PODIATRIST/OWNER
Name	:	DR. LATASHIA J WEBB
Credential	:	D.P.M.
Telephone Number	:	229-588-6843

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	12/27/2010

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