Organization
FAMILY PODIATRY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT WILLIAM CUSHNER DPM (OWNER/CEO)
(912) 489-8727
Entity
Organization
Contact information
Practice address
95 BEL AIR DR, STATESBORO, GA 30461-6879
(912) 489-8727
(912) 764-7882
Mailing address
PO BOX 1106, STATESBORO, GA 30459-1106
(912) 489-8727
(912) 764-7882
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0867410001
MEDICARE DMERC PROVIDER
GA
Enumeration date
08/31/2006
Last updated
11/03/2008
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