Healthcare Provider Details

I. General information

NPI: 1164797221
Provider Name (Legal Business Name): LAFAYETTE FOOT & LEG SPECIALIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W DOUBLEGATE DR
ALBANY GA
31721-9234
US

IV. Provider business mailing address

2600 W DOUBLEGATE DR
ALBANY GA
31721-9234
US

V. Phone/Fax

Practice location:
  • Phone: 229-436-3056
  • Fax: 229-346-3056
Mailing address:
  • Phone: 229-436-3056
  • Fax: 226-436-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD000760
License Number StateGA

VIII. Authorized Official

Name: DR. HOANG LAFAYETTE
Title or Position: PODIATRISTS-D.P.M.
Credential:
Phone: 229-436-3056