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General NPI Number Information
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NPI Number | 1457308132
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Entity Type | Organization
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Legal Business Name | PERSONAL FOOT AND ANKLE SPECIALIST
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 1240 GA HIGHWAY 15 N
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City | SANDERSVILLE
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State | GA
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Zip | 31082-7303
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Country | US
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Telephone | 478-552-1086
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Fax | 478-552-6333
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Provider Business Mailing Address
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Address Line | PO BOX 5969
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City | SANDERSVILLE
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State | GA
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Zip | 31082-5969
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Country | US
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Telephone | 478-552-1086
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Fax | 478-552-6333
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THUY GIANG
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Credential | DPM
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Telephone | 478-552-1086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | POD000790
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License Number State | GA
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