Healthcare Provider Details

I. General information

NPI: 1194273607
Provider Name (Legal Business Name): MARSHALL COUNTY FOOT CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 US HIGHWAY 431 STE B
ALBERTVILLE AL
35950-0203
US

IV. Provider business mailing address

601A CORLEY AVE
BOAZ AL
35957-5957
US

V. Phone/Fax

Practice location:
  • Phone: 256-840-4810
  • Fax: 256-840-4815
Mailing address:
  • Phone: 256-840-4810
  • Fax: 256-840-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBSON F ARAUJO
Title or Position: OWNER
Credential: DPM
Phone: 256-840-4810