Healthcare Provider Details

I. General information

NPI: 1023285996
Provider Name (Legal Business Name): COMPREHENSIVE FOOT AND ANKLE CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2008
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MARGIE DR
WARNER ROBINS GA
31088-7818
US

IV. Provider business mailing address

PO BOX 6377
WARNER ROBINS GA
31095-6377
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-2362
  • Fax: 478-333-2363
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000722
License Number StateGA

VIII. Authorized Official

Name: DR. DWIGHT MCLEISH
Title or Position: OWNER
Credential: MD
Phone: 478-333-2362