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General NPI Number Information
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NPI Number | 1053684399
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE PUTNAM DPM
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Gender | Female
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 110 HILL POND LN
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City | STATESBORO
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State | GA
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Zip | 30458-0872
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Country | US
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Telephone | 912-489-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 803 E 68TH ST
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City | SAVANNAH
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State | GA
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Zip | 31405-4709
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Country | US
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Telephone | 912-355-4557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | E4984
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD001205
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License Number State | GA
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