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General NPI Number Information
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NPI Number | 1508261991
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Entity Type | Organization
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Legal Business Name | MY FOOT DOCTOR PLLC
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 705 COOK DR SUITE 200
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City | ATHENS
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State | TN
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Zip | 37303-3494
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Country | US
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Telephone | 423-744-9399
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Fax | 423-744-3067
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Provider Business Mailing Address
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Address Line | 106 STUART RD NE
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City | CLEVELAND
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State | TN
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Zip | 37312-4803
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Country | US
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Telephone | 423-559-9700
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Fax | 423-472-7785
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Authorized Official
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Title or Position | OWNER
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Name | BARRY SCHULMAN
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Credential | DPM
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Telephone | 423-559-9700
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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 | DPM0000000597
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License Number State | TN
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