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General NPI Number Information
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NPI Number | 1174736706
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Entity Type | Organization
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Legal Business Name | CROCKETT FOOT AND ANKLE CLINIC, INC.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 369 BRINK ST
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-3243
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Country | US
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Telephone | 931-766-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 369 BRINK ST
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-3243
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Country | US
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Telephone | 931-766-3040
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAMES L CHADBURN
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Credential | DPM
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Telephone | 931-766-3040
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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 | 667
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License Number State | TN
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