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General NPI Number Information
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NPI Number | 1023285996
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE FOOT AND ANKLE CENTER,LLC
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Dates
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Enumeration Date | 05/10/2008
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 321 MARGIE DR
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City | WARNER ROBINS
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State | GA
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Zip | 31088-7818
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Country | US
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Telephone | 478-333-2362
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Fax | 478-333-2363
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Provider Business Mailing Address
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Address Line | PO BOX 6377
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City | WARNER ROBINS
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State | GA
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Zip | 31095-6377
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DWIGHT MCLEISH
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Credential | MD
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Telephone | 478-333-2362
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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 | 000722
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License Number State | GA
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