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General NPI Number Information
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NPI Number | 1780803528
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Entity Type | Organization
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Legal Business Name | ADULT & CHILD FOOT & ANKLE CARE, LLC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 6512 WOODLAKE VILLAGE CIR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2200
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Country | US
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Telephone | 804-739-6730
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Fax | 804-739-6894
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Provider Business Mailing Address
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Address Line | 6512 WOODLAKE VILLAGE CIR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2200
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Country | US
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Telephone | 804-739-6730
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Fax | 804-739-6894
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN GERALD MCMAHON JR.
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Credential | DPM
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Telephone | 804-739-6730
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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 | 0103300915
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License Number State | VA
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