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General NPI Number Information
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NPI Number | 1366560732
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Entity Type | Organization
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Legal Business Name | A FAMILY FOOTCARE CENTER
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 1078 CLEVELAND AVE
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City | EAST POINT
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State | GA
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Zip | 30344-6741
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Country | US
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Telephone | 404-768-0000
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Fax | 404-768-0055
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Provider Business Mailing Address
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Address Line | 1078 CLEVELAND AVE
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City | EAST POINT
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State | GA
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Zip | 30344-6741
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Country | US
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Telephone | 404-768-0000
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Fax | 404-768-0055
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY R GILGER
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Credential | DPM
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Telephone | 404-768-0000
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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 | 366
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License Number State | GA
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