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General NPI Number Information
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NPI Number | 1124152459
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT AND ANKLE CTR
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 407 BARRINGTON PT
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City | MACON
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State | GA
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Zip | 31220-8754
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Country | US
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Telephone | 478-390-2178
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Fax | 478-471-0104
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Provider Business Mailing Address
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Address Line | 841 MULBERRY ST
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City | MACON
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State | GA
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Zip | 31201-6756
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Country | US
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Telephone | 478-741-1192
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Fax | 478-741-0029
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Authorized Official
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Title or Position | PODIATRIST
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Name | ROGER PETER THEODORE
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Credential | DPM
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Telephone | 478-390-2178
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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 | POD000753
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License Number State | GA
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