Provider Demographics
NPI:1235642026
Name:THOMAS FOOT AND ANKLE CLINIC LLC
Entity type:Organization
Organization Name:THOMAS FOOT AND ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-244-5104
Mailing Address - Street 1:410 CONNELL RD STE E
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1898
Mailing Address - Country:US
Mailing Address - Phone:229-244-5104
Mailing Address - Fax:229-242-1725
Practice Address - Street 1:410 CONNELL RD STE E
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1898
Practice Address - Country:US
Practice Address - Phone:229-244-5104
Practice Address - Fax:229-242-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty