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General NPI Number Information
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NPI Number | 1043574643
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Entity Type | Organization
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Legal Business Name | FYNE FOOT CARE CENTER
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 1710 CENTRAL AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-5733
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Country | US
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Telephone | 706-373-4402
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 CENTRAL AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-5733
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Country | US
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Telephone | 706-373-4402
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. LATANYA PATTERSON-FYNE
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Credential | D.P.M.
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Telephone | 706-373-4402
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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 | POD000619
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License Number State | GA
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