Provider Demographics
NPI:1447468012
Name:DIABETIC FOOTCARE INC
Entity type:Organization
Organization Name:DIABETIC FOOTCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:FAIRCLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-589-7807
Mailing Address - Street 1:1866 OLD SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:MIDVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30441-4420
Mailing Address - Country:US
Mailing Address - Phone:478-589-7807
Mailing Address - Fax:478-589-7923
Practice Address - Street 1:1866 OLD SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:MIDVILLE
Practice Address - State:GA
Practice Address - Zip Code:30441-4420
Practice Address - Country:US
Practice Address - Phone:478-589-7807
Practice Address - Fax:478-589-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4537110001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies