Healthcare Provider Details

I. General information

NPI: 1073557799
Provider Name (Legal Business Name): PRIME FOOT CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 SANDIDGE CENTER COVE STE C
OLIVE BRANCH MS
38654-3574
US

IV. Provider business mailing address

9065 SANDIDGE CENTER COVE STE C
OLIVE BRANCH MS
38654-3574
US

V. Phone/Fax

Practice location:
  • Phone: 662-893-0533
  • Fax: 662-985-6821
Mailing address:
  • Phone: 662-893-0533
  • Fax: 662-890-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number80159
License Number StateMS

VIII. Authorized Official

Name: DR. CARLA ARNETTE MARTIN
Title or Position: PODTIATRIST
Credential: DPM
Phone: 662-893-0533