Healthcare Provider Details

I. General information

NPI: 1922296250
Provider Name (Legal Business Name): DALTON FOOT & ANKLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 BROADRICK DRIVE
DALTON GA
30720
US

IV. Provider business mailing address

1432 BROADRICK DRIVE
DALTON GA
30720
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-1130
  • Fax: 706-272-7043
Mailing address:
  • Phone: 706-226-1130
  • Fax: 706-272-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SPENCER CARLTON MISNER
Title or Position: PROVIDER MEDICAL DIRECTOR
Credential: DPM
Phone: 706-226-1130