Individual
DR. MARY L OTTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1515 LANEY WALKER BLVD, AUGUSTA, GA 30904-5827
(706) 724-0586
(706) 724-4468
Mailing address
1515 LANEY WALKER BLVD, AUGUSTA, GA 30904-5827
(706) 724-0586
(706) 724-4468
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
GA520
GA
213ER0200X
Radiology Podiatrist
GA520
GA
213ES0000X
Sports Medicine Podiatrist
GA520
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
GA520
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000314278C
—
GA
01
—
GA520
STATE LICENSE NUMBER
GA
05
—
GPO520
—
SC
Enumeration date
01/16/2007
Last updated
06/25/2008
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