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General NPI Number Information
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NPI Number | 1760967434
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Entity Type | Organization
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Legal Business Name | INNOVATIVE FOOTCARE, INC.
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 1105 E MAIN ST
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City | ROYSTON
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State | GA
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Zip | 30662-3803
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Country | US
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Telephone | 762-338-5152
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Fax | 762-338-5152
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Provider Business Mailing Address
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Address Line | 1105 E MAIN ST
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City | ROYSTON
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State | GA
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Zip | 30662-3803
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Country | US
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Telephone | 762-338-5152
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Fax | 762-338-5152
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DEBBIE MEEKS
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Credential |
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Telephone | 470-503-9934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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