Healthcare Provider Details

I. General information

NPI: 1194463562
Provider Name (Legal Business Name): FEETFEELFINEPODIATRYSERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 UNIVERSITY AVE SE APT 514
MINNEAPOLIS MN
55414-4435
US

IV. Provider business mailing address

2929 UNIVERSITY AVE SE APT 514
MINNEAPOLIS MN
55414-4435
US

V. Phone/Fax

Practice location:
  • Phone: 678-800-3273
  • Fax:
Mailing address:
  • Phone: 678-800-3273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. STACEY LAMAR SCOTTON
Title or Position: PHYSICIAN
Credential: DPM
Phone: 678-800-3273