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Organization
S.E. FAMILY FOOT & ANKLE CENTER LLC
Active
Organization
S.E. FAMILY FOOT & ANKLE CENTER LLC
Active
Other names
Family Foot and Ankle Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER P. THEODORE DR. (OWNER)
(478) 741-1192
Entity
Organization
Contact information
Practice address
841 MULBERRY ST, MACON, GA 31201-6756
(478) 741-1192
(478) 471-0029
Mailing address
841 MULBERRY ST, MACON, GA 31201-6756
(478) 741-1192
(478) 471-0029
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000753
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006555322A
—
GA
01
—
480025693
RAILROAD MEDICARE
GA
Enumeration date
07/23/2009
Last updated
07/23/2009
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