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General NPI Number Information
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NPI Number | 1023252012
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Entity Type | Organization
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Legal Business Name | COMFORT FOOT CARE LLC
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 6116 SHALLOWFORD RD STE 118
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7201
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Country | US
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Telephone | 423-710-1224
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Fax | 423-710-1228
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Provider Business Mailing Address
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Address Line | 6116 SHALLOWFORD RD STE 118
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7201
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Country | US
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Telephone | 423-710-1224
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Fax | 423-710-1228
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIO S DICKENS
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Credential | DPM
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Telephone | 423-710-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DPM0000000690
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License Number State | TN
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