Healthcare Provider Details

I. General information

NPI: 1922490366
Provider Name (Legal Business Name): GA FOOT AND ANKLE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10164 FORD AVE SUITE B
RICHMOND HILL GA
31324-3949
US

IV. Provider business mailing address

310 EISENHOWER DR BUILDING 7A
SAVANNAH GA
31406-2632
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-6503
  • Fax: 912-355-9837
Mailing address:
  • Phone: 912-355-6503
  • Fax: 912-355-9837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number885
License Number StateGA

VIII. Authorized Official

Name: KIMBERLY VARNER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 912-355-6503