# COASTAL FOOT & ANKLE WELLNESS CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972834760
- **Authorized official:** DR. RICHARD W JOHNSON DPM (OWNER)
- **Authorized official phone:** (904) 826-1900

## Contact information

- **Practice address:** 1740 TREE BLVD STE 112, ST AUGUSTINE, FL 32084-5720
- **Practice address phone:** (904) 826-1900
- **Practice address fax:** (904) 826-1920
- **Mailing address:** 1740 TREE BLVD STE 112, ST AUGUSTINE, FL 32084-5720
- **Mailing address phone:** (904) 826-1900
- **Mailing address fax:** (904) 826-1920

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | P02829 | FL | Yes |

## Other

- **Enumeration date:** 01/19/2010
- **Last updated:** 12/27/2020