Organization Name: | SOUTH FULTON FAMILY FOOT CARE, INC. |
NPI Number: | 1154536126 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RONA RENELL GREEN (CEO) |
Mailing Address: | 67 W Campbellton St Fairburn |
State: | GA US |
Postal Code: | 302131338 |
Phone Number: | 7709642201 |
Fax Number: | 7703069744 |
NPI Enumeration Date: | 05/13/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP1100X |
License Number: | 697 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Podiatric |
Taxonomy Definition: |