Provider Demographics
NPI:1538373261
Name:SOUTHERN FOOT & ANKLE CENTER PC
Entity type:Organization
Organization Name:SOUTHERN FOOT & ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-562-7092
Mailing Address - Street 1:836 E 65TH ST
Mailing Address - Street 2:#9
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4434
Mailing Address - Country:US
Mailing Address - Phone:912-355-3555
Mailing Address - Fax:912-355-4499
Practice Address - Street 1:836 E 65TH ST
Practice Address - Street 2:# 9
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4434
Practice Address - Country:US
Practice Address - Phone:912-355-3555
Practice Address - Fax:912-355-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480033251OtherRAILROAD MEDICARE
GA00812644IMedicaid
SC8121Medicare PIN
GAU73444Medicare UPIN
GA00812644IMedicaid