Healthcare Provider Details

I. General information

NPI: 1447362298
Provider Name (Legal Business Name): FAMILY PODIATRY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BEL AIR DR
STATESBORO GA
30461-6879
US

IV. Provider business mailing address

PO BOX 1106
STATESBORO GA
30459-1106
US

V. Phone/Fax

Practice location:
  • Phone: 912-489-8727
  • Fax: 912-764-7882
Mailing address:
  • Phone: 912-489-8727
  • Fax: 912-764-7882

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. ROBERT WILLIAM CUSHNER
Title or Position: OWNER/CEO
Credential: DPM
Phone: 912-489-8727