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General NPI Number Information
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NPI Number | 1790840080
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Entity Type | Organization
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Legal Business Name | PREMIER FOOT CLINIC PC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 705 HIGHWAY 80 W
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City | CLINTON
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State | MS
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Zip | 39056-4103
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Country | US
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Telephone | 601-926-1500
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Fax | 601-926-1502
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Provider Business Mailing Address
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Address Line | 705 HIGHWAY 80 W
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City | CLINTON
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State | MS
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Zip | 39056-4103
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Country | US
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Telephone | 601-926-1500
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Fax | 601-926-1502
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. STEFANIE MONIQUE THOMAS
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Credential | DPM
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Telephone | 601-926-1500
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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 | 80151
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License Number State | MS
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