Provider Demographics
NPI:1043574643
Name:FYNE FOOT CARE CENTER
Entity type:Organization
Organization Name:FYNE FOOT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON-FYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-373-4402
Mailing Address - Street 1:1710 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5733
Mailing Address - Country:US
Mailing Address - Phone:706-373-4402
Mailing Address - Fax:
Practice Address - Street 1:1710 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5733
Practice Address - Country:US
Practice Address - Phone:706-373-4402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000619213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty