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General NPI Number Information
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NPI Number | 1316226780
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Entity Type | Organization
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Legal Business Name | FOOT, ANKLE & LEG CENTER OF ROME LLC
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 126 THREE RIVERS DR NE
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City | ROME
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State | GA
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Zip | 30161-4999
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Country | US
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Telephone | 706-232-4577
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Fax | 706-232-6750
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Provider Business Mailing Address
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Address Line | 126 THREE RIVERS DR NE
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City | ROME
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State | GA
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Zip | 30161-4999
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Country | US
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Telephone | 706-232-4577
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Fax | 706-232-6750
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Authorized Official
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Title or Position | C.E.O
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Name | DR. AZUKA IFEYINWA NWAEDOZIE
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Credential | D.P.M
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Telephone | 706-232-4577
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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 | POD001142
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License Number State | GA
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