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General NPI Number Information
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NPI Number | 1861615239
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Entity Type | Organization
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Legal Business Name | ETOWAH FOOT SPECIALISTS, INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 230 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-4214
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Country | US
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Telephone | 256-549-7890
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Fax | 256-549-7891
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Provider Business Mailing Address
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Address Line | 230 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-4214
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Country | US
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Telephone | 256-549-7890
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Fax | 256-549-7891
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHANNON MARIE DEATON
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Credential | D.P.M.
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Telephone | 256-549-7890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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