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Individual provider · Foot & Ankle Surgery Podiatrist · Macon, GA

NPI
1124036934
Type
Individual (Type 1)
Primary specialty
Foot & Ankle Surgery Podiatrist (Podiatrist)
Specialty group
Podiatric Medicine & Surgery Service Providers
Taxonomy code
213ES0103X
License number
POD001232 (GA)
Sex
Male
Sole proprietor
Yes
Enumerated
2006-08-04
Last updated
2016-04-09
Practice location
2180 Vineville Ave
Macon, GA 31204-3124
(478) 742-3631

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