MEDICARE: ANKLE AND FOOT ASSOC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1720528920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANKLE AND FOOT ASSOC, LLC

Provider Business Mailing Address
First Line	:	501 W ONEIDA ST
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-5337
Country	:	US
Telephone Number	:	912-283-6471
Fax Number	:	912-283-3590

Provider Business Practice Location Address
First Line	:	481 E G MILES PKWY
Second Line	:	SUITE C
City	:	HINESVILLE
State	:	GA
Zip	:	31313-4006
Country	:	US
Telephone Number	:	912-432-7236
Fax Number	:	912-432-7243

Authorized Official
Title or Position	:	CEO
Name	:	DAVID P MURPHY
Credential	:	DPM
Telephone Number	:	912-283-6471

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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