Provider Demographics
NPI:1235458084
Name:JPFO, LLC
Entity type:Organization
Organization Name:JPFO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:PEARCE
Authorized Official - Last Name:FUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:D,PM
Authorized Official - Phone:229-293-8337
Mailing Address - Street 1:2410 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2533
Mailing Address - Country:US
Mailing Address - Phone:229-293-8337
Mailing Address - Fax:229-293-8338
Practice Address - Street 1:2410 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2533
Practice Address - Country:US
Practice Address - Phone:229-293-8337
Practice Address - Fax:229-293-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001085213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty