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General NPI Number Information
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NPI Number | 1740499664
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT CARE OF STATESBORO
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 407 S ZETTEROWER AVE
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City | STATESBORO
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State | GA
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Zip | 30458-7137
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Country | US
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Telephone | 912-489-3668
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Fax | 912-489-4795
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Provider Business Mailing Address
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Address Line | PO BOX 886
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City | STATESBORO
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State | GA
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Zip | 30459-0886
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Country | US
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Telephone | 912-489-3668
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Fax | 912-489-4795
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. KATHLEEN ROSE SKELLY
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Credential | DPM
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Telephone | 912-489-3668
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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 | POD000942
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License Number State | GA
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