Provider Demographics
NPI:1538225602
Name:PODIATRY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:TUCKER
Authorized Official - Last Name:BRAWNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM
Authorized Official - Phone:912-354-9990
Mailing Address - Street 1:817 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4507
Mailing Address - Country:US
Mailing Address - Phone:912-354-9990
Mailing Address - Fax:912-352-2304
Practice Address - Street 1:817 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4507
Practice Address - Country:US
Practice Address - Phone:912-354-9990
Practice Address - Fax:912-352-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000456213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000178912AMedicaid
GA000178912AMedicaid
GAGRP5085Medicare PIN
GA0888970001Medicare NSC