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Organization
FAMILY FOOT AND ANKLE CTR
Active
Organization
FAMILY FOOT AND ANKLE CTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER PETER THEODORE DPM (PODIATRIST)
(478) 390-2178
Entity
Organization
Contact information
Practice address
407 BARRINGTON PT, MACON, GA 31220-8754
(478) 390-2178
(478) 471-0104
Mailing address
841 MULBERRY ST, MACON, GA 31201-6756
(478) 741-1192
(478) 741-0029
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD000753
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00655322A
—
GA
01
—
480018494
RAILROAD MEDICARE
—
01
—
480025693
RAILROAD MEDICARE
—
Enumeration date
03/16/2007
Last updated
08/22/2024
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