Healthcare Provider Details

I. General information

NPI: 1760640460
Provider Name (Legal Business Name): MIDTOWN FOOT CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 ABERCORN ST
SAVANNAH GA
31401-5912
US

IV. Provider business mailing address

PO BOX 30306
SAVANNAH GA
31410-0306
US

V. Phone/Fax

Practice location:
  • Phone: 912-233-5316
  • Fax: 912-233-3859
Mailing address:
  • Phone: 912-233-5316
  • Fax: 912-233-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000566
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000566
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000566
License Number StateGA

VIII. Authorized Official

Name: TERESA MURRELL
Title or Position: CFO
Credential:
Phone: 912-233-5316