Provider Demographics
NPI:1962136457
Name:FOOT SPECIALISTS OF ALABAMA LLC
Entity type:Organization
Organization Name:FOOT SPECIALISTS OF ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DPM
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GRIMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:256-571-8750
Mailing Address - Street 1:7633 AL HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7137
Mailing Address - Country:US
Mailing Address - Phone:256-571-8750
Mailing Address - Fax:256-571-8767
Practice Address - Street 1:7633 AL HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7137
Practice Address - Country:US
Practice Address - Phone:256-571-8750
Practice Address - Fax:256-571-8767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT SPECIALIST OF ALABAMA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-12
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty