Healthcare Provider Details

I. General information

NPI: 1366513988
Provider Name (Legal Business Name): AUGUSTA FOOT & ANKLE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 WAINBROOK DR
AUGUSTA GA
30909-6289
US

IV. Provider business mailing address

1416 WAINBROOK DR
AUGUSTA GA
30909-6289
US

V. Phone/Fax

Practice location:
  • Phone: 706-262-3668
  • Fax: 706-262-3670
Mailing address:
  • Phone: 706-262-3668
  • Fax: 706-262-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPOD000842
License Number StateGA

VIII. Authorized Official

Name: BRIAN NATHAN BENNETT
Title or Position: PHYSICIAN
Credential: DPM
Phone: 706-312-3668