Healthcare Provider Details

I. General information

NPI: 1154684819
Provider Name (Legal Business Name): THE FOOT GROUP P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 04/19/2020
Certification Date: 04/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N MALONE ST
ATHENS AL
35611-1509
US

IV. Provider business mailing address

PO BOX 6487
HUNTSVILLE AL
35813-0487
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-2009
  • Fax: 256-774-8211
Mailing address:
  • Phone: 256-772-8566
  • Fax: 256-774-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number164
License Number StateAL

VIII. Authorized Official

Name: DR. TARA L.F. BLASINGAME
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 256-232-2009