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General NPI Number Information
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NPI Number | 1023326220
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Entity Type | Organization
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Legal Business Name | FAMILY PODIATRY CENTER PC
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 125A VICTORY DR
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City | SWAINSBORO
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State | GA
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Zip | 30401
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Country | US
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Telephone | 912-489-8727
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Fax | 912-764-7882
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Provider Business Mailing Address
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Address Line | 95 BEL-AIR DRIVE
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City | STATESBORO
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State | GA
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Zip | 30461-6879
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Country | US
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Telephone | 912-489-8727
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Fax | 912-764-7882
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | DR. ROBERT W CUSHNER
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Credential | DPM
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Telephone | 912-489-8727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD000942
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License Number State | GA
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