Individual
TONDA RENEE WOOTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
4660 RIVERSIDE PARK BLVD, MACON, GA 31210-1395
(478) 474-2114
(478) 474-8745
Mailing address
4660 RIVERSIDE PARK BLVD STE A, MACON, GA 31210-1399
(478) 474-2114
(478) 474-8001
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
000000
AZ
213ES0103X
Foot & Ankle Surgery Podiatrist
00451
KY
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001462
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00451
KENTUCKY STATE LICENSE
KY
Enumeration date
06/30/2016
Last updated
07/31/2023
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