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General NPI Number Information
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NPI Number | 1376642215
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Entity Type | Organization
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Legal Business Name | WILLIAMSON FOOT CLINIC, PLLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 28531 US HIGHWAY 119 STE 202
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City | SOUTH WILLIAMSON
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State | KY
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Zip | 41503-3928
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Country | US
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Telephone | 606-237-5000
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Fax | 606-237-5001
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Provider Business Mailing Address
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Address Line | 28531 US HIGHWAY 119 STE 202
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City | SOUTH WILLIAMSON
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State | KY
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Zip | 41503-3928
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Country | US
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Telephone | 606-237-5000
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Fax | 606-237-5001
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. KENNETH BURTON AVERY
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Credential | D.P.M.
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Telephone | 606-237-5000
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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 | 00295
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License Number State | KY
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