Provider Demographics
NPI:1730598079
Name:WALK WELL FOOTCARE CENTER, LLC
Entity type:Organization
Organization Name:WALK WELL FOOTCARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:NAWANJAYA
Authorized Official - Last Name:WEJULI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-542-0830
Mailing Address - Street 1:212 GA HIGHWAY 49 N
Mailing Address - Street 2:SUITE 900
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-4057
Mailing Address - Country:US
Mailing Address - Phone:305-542-0830
Mailing Address - Fax:
Practice Address - Street 1:212 GA HIGHWAY 49 N
Practice Address - Street 2:SUITE 900
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-4057
Practice Address - Country:US
Practice Address - Phone:305-542-0830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicare PIN