Healthcare Provider Details

I. General information

NPI: 1720139710
Provider Name (Legal Business Name): THE FOOT AND ANKLE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LANEY WALKER BLVD
AUGUSTA GA
30904-5827
US

IV. Provider business mailing address

1515 LANEY WALKER BLVD
AUGUSTA GA
30904-5827
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-0586
  • Fax: 706-724-4468
Mailing address:
  • Phone: 706-724-0586
  • Fax: 706-724-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberGRP2839
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberGRP2839
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberGRP2839
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1196250004
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberGRP2839
License Number StateGA

VIII. Authorized Official

Name: DR. KILE WOODROW KINNEY
Title or Position: CORPORATION PRESIDENT
Credential: DPM
Phone: 706-724-0586