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General NPI Number Information
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NPI Number | 1972856029
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Entity Type | Organization
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Legal Business Name | ADVANCED REGIONAL FOOT CLINIC PLLC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 1720 E REELFOOT AVE SUITE 204
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City | UNION CITY
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State | TN
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Zip | 38261-6047
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Country | US
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Telephone | 731-885-7834
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 E REELFOOT AVE SUITE 204
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City | UNION CITY
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State | TN
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Zip | 38261-6047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | BHEKUMUZI M KHUMALO
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Credential | DPM
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Telephone | 731-885-7834
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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 |
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License Number State |
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