Healthcare Provider Details

I. General information

NPI: 1437686425
Provider Name (Legal Business Name): MARSHALL COUNTY FOOT CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 AL HIGHWAY 69
GUNTERSVILLE AL
35976-7137
US

IV. Provider business mailing address

601A CORLEY AVE
BOAZ AL
35957-5957
US

V. Phone/Fax

Practice location:
  • Phone: 256-571-8750
  • Fax: 256-571-8767
Mailing address:
  • Phone: 256-840-4810
  • Fax: 256-840-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

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