Provider Demographics
NPI:1902596448
Name:PREMIER FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:PREMIER FOOT & ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALANDA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-461-7149
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-0025
Mailing Address - Country:US
Mailing Address - Phone:704-624-7090
Mailing Address - Fax:704-624-7029
Practice Address - Street 1:119 E UNION ST
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1142
Practice Address - Country:US
Practice Address - Phone:910-461-7149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty