Healthcare Provider Details

I. General information

NPI: 1518082353
Provider Name (Legal Business Name): PERSONAL FOOT & ANKLE SPECIALIST,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S MARCUS ST
WRIGHTSVILLE GA
31096-1517
US

IV. Provider business mailing address

PO BOX 5969
SANDERSVILLE GA
31082-5969
US

V. Phone/Fax

Practice location:
  • Phone: 478-864-1114
  • Fax: 478-552-6333
Mailing address:
  • Phone: 478-864-1114
  • Fax: 478-552-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000790
License Number StateGA

VIII. Authorized Official

Name: DR. THUY D GIANG
Title or Position: PRESIDENT
Credential: DPM
Phone: 478-552-1086