Healthcare Provider Details

I. General information

NPI: 1033175690
Provider Name (Legal Business Name): ADVANCED FOOT HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 LURLEEN B WALLACE BLVD
NORTHPORT AL
35476-3947
US

IV. Provider business mailing address

PO BOX 661495
BIRMINGHAM AL
35266-1495
US

V. Phone/Fax

Practice location:
  • Phone: 205-330-9898
  • Fax: 205-330-9920
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MS. HOLLY ROSEN
Title or Position: PRESIDENT
Credential:
Phone: 205-330-9898