Healthcare Provider Details

I. General information

NPI: 1295940260
Provider Name (Legal Business Name): GREATER ALABAMA FAMILY FOOT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 VETERANS MEMORIAL PKWY
LANETT AL
36863-2840
US

IV. Provider business mailing address

PO BOX 1026
LANETT AL
36863-1026
US

V. Phone/Fax

Practice location:
  • Phone: 334-642-3668
  • Fax: 334-642-3669
Mailing address:
  • Phone: 334-642-3668
  • Fax: 334-642-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number193
License Number StateAL

VIII. Authorized Official

Name: DR. RONA RENELL GREEN
Title or Position: CEO
Credential: DPM
Phone: 334-642-3668