Healthcare Provider Details

I. General information

NPI: 1952611543
Provider Name (Legal Business Name): FAMILY FOOT AND ANKLE PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 E. FIRETOWER ROAD
GREENVILLE NC
27858-4105
US

IV. Provider business mailing address

1432 E. FIRETOWER ROAD
GREENVILLE NC
27858-4105
US

V. Phone/Fax

Practice location:
  • Phone: 252-439-1150
  • Fax: 252-439-1152
Mailing address:
  • Phone: 252-439-1150
  • Fax: 252-439-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number537
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number581
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number537
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number412
License Number StateNC

VIII. Authorized Official

Name: DEBBIE RAVN
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-439-1150