Healthcare Provider Details

I. General information

NPI: 1649021627
Provider Name (Legal Business Name): PROFESSIONAL FOOTCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 BRIARWOOD DR STE 400
JACKSON MS
39206-3063
US

IV. Provider business mailing address

406 BRIARWOOD DR STE 400
JACKSON MS
39206-3063
US

V. Phone/Fax

Practice location:
  • Phone: 601-977-9002
  • Fax: 702-977-9005
Mailing address:
  • Phone: 601-977-9002
  • Fax: 702-977-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL BOYKINS
Title or Position: OWNER
Credential:
Phone: 601-291-0036