Organization
SOUTHERN PODIATRY FOOT AND ANKLE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELYSE N TILLER (CPCS)
(615) 956-7919
Entity
Organization
Contact information
Practice address
8000 MADISON BLVD STE D102-341, MADISON, AL 35758-2031
(312) 752-7713
Mailing address
1311 GRANDEVIEW BLVD APT 1928, HUNTSVILLE, AL 35824-2408
(312) 752-7713
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
299
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112600
—
AL
01
—
510-49599
BCBSAL
AL
Enumeration date
07/13/2009
Last updated
12/12/2024
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