Healthcare Provider Details

I. General information

NPI: 1679913180
Provider Name (Legal Business Name): KAREN ANN FLOYD ORTHOTIC SHOE FITTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 PEMBROKE PT
CENTERVILLE GA
31028-8041
US

IV. Provider business mailing address

304 PEMBROKE PT
CENTERVILLE GA
31028-8041
US

V. Phone/Fax

Practice location:
  • Phone: 478-213-5233
  • Fax: 888-845-8243
Mailing address:
  • Phone: 478-213-5233
  • Fax: 888-845-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: