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General NPI Number Information
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NPI Number | 1275702086
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Entity Type | Organization
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Legal Business Name | FOOT GROUP INC
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 10918 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37934-2931
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Country | US
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Telephone | 865-966-5775
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Fax | 865-966-5743
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Provider Business Mailing Address
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Address Line | PO BOX 22429
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City | KNOXVILLE
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State | TN
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Zip | 37933-0429
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Country | US
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Telephone | 865-966-5775
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Fax | 865-966-5743
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Authorized Official
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Title or Position | OWNER
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Name | WAYNE STEVEN DAVIS
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Credential | DPM
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Telephone | 865-966-5775
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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 | DPM170
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License Number State | TN
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