Healthcare Provider Details

I. General information

NPI: 1922043140
Provider Name (Legal Business Name): SOUTH BALDWIN PODIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 N ALSTON ST
FOLEY AL
36535-2274
US

IV. Provider business mailing address

1770 N ALSTON ST
FOLEY AL
36535-2274
US

V. Phone/Fax

Practice location:
  • Phone: 251-943-3668
  • Fax: 251-943-3314
Mailing address:
  • Phone: 251-943-3668
  • Fax: 251-943-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number244
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KERI KRAFT
Title or Position: OFFICE MANAGER
Credential:
Phone: 251-943-3668