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General NPI Number Information
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NPI Number | 1407025935
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Entity Type | Organization
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Legal Business Name | ADULT AND PEDIATRIC FOOT CENTER, LLC
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 5362 ESTATE OFFICE DR SUITE 1
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City | MEMPHIS
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State | TN
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Zip | 38119-3635
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Country | US
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Telephone | 901-537-0078
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Fax | 901-537-0096
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Provider Business Mailing Address
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Address Line | 5362 ESTATE OFFICE DR SUITE 1
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City | MEMPHIS
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State | TN
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Zip | 38119-3635
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Country | US
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Telephone | 901-537-0078
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Fax | 901-537-0096
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTONIO LAVALE KNOWLES
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Credential | DPM
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Telephone | 901-537-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 4822210
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License Number State | TN
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