Healthcare Provider Details

I. General information

NPI: 1316167349
Provider Name (Legal Business Name): DENMARK FOOT AND ANKLE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 WRIGHTSBORO RD SUITE 154
AUGUSTA GA
30904-4764
US

IV. Provider business mailing address

2260 WRIGHTSBORO RD SUITE 154
AUGUSTA GA
30904-4764
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-0263
  • Fax:
Mailing address:
  • Phone: 706-364-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD000953
License Number StateGA

VIII. Authorized Official

Name: DR. JAMES AUSTIN DENMARK
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 706-364-0263