Healthcare Provider Details

I. General information

NPI: 1235792847
Provider Name (Legal Business Name): FAWG SOLEHEALERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HAMILTON RD
COLUMBUS GA
31904-8927
US

IV. Provider business mailing address

2000 HAMILTON RD
COLUMBUS GA
31904-8927
US

V. Phone/Fax

Practice location:
  • Phone: 706-327-8819
  • Fax: 706-327-3147
Mailing address:
  • Phone: 706-327-8819
  • Fax: 706-327-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A SCHRECK
Title or Position: OWNER/PARTNERSHIP
Credential: DPM
Phone: 706-327-8819