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General NPI Number Information
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NPI Number | 1649648569
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Entity Type | Organization
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Legal Business Name | FEET FIRST PODIATRY, LLC
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 440 CHARTER BLVD STE 2202
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City | MACON
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State | GA
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Zip | 31210-0705
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Country | US
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Telephone | 478-741-4332
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Fax | 478-741-4343
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Provider Business Mailing Address
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Address Line | PO BOX 4124
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City | MACON
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State | GA
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Zip | 31208-4124
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Country | US
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Telephone | 478-741-4332
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Fax | 478-741-4343
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CONSUELA M WILLIAMS-HOLLIDAY
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Credential | DPM
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Telephone | 478-741-4332
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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 | POD000981
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License Number State | GA
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