Provider Demographics
NPI:1992969992
Name:FOOT AND LEG CENTERS OF AMERICA
Entity type:Organization
Organization Name:FOOT AND LEG CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:VITO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-475-9250
Mailing Address - Street 1:3556 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2509
Mailing Address - Country:US
Mailing Address - Phone:478-475-9250
Mailing Address - Fax:478-475-7920
Practice Address - Street 1:3556 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2509
Practice Address - Country:US
Practice Address - Phone:478-475-9250
Practice Address - Fax:478-475-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA48SCBNTMedicare PIN
GA511I480015Medicare PIN