Provider Demographics
NPI:1154889533
Name:CUTTING EDGE FOOT AND ANKLE CLINIC, PLLC
Entity type:Organization
Organization Name:CUTTING EDGE FOOT AND ANKLE CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YERUSALEM
Authorized Official - Middle Name:ABEBE
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:615-866-9639
Mailing Address - Street 1:1725 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5705
Mailing Address - Country:US
Mailing Address - Phone:615-582-5069
Mailing Address - Fax:
Practice Address - Street 1:3443 DICKERSON PIKE STE 740
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2527
Practice Address - Country:US
Practice Address - Phone:615-866-9639
Practice Address - Fax:615-915-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN106571775OtherDRIVER LICENSE