Latanya P. Fyne, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

000619 Issued in GA

Practice address

1710 Central Ave.
Augusta, GA 30904-5850

Phone

(706) 373-4402

Fax

(706) 364-8628

NPI assigned

Aug 30, 2006

Last updated

Apr 4, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mystic Medical LLCGroup PAC ID 6305165655, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mystic Medical, LLC

  • Foot & Ankle Surgery Podiatrist
  • Atlanta, GA
  • NPI 1093108763
  Medicare reassignment Care Compare group NPD (past)
• Fyne Foot Care Center

  • Foot & Ankle Surgery Podiatrist
  • Augusta, GA
  • NPI 1043574643
  Medicare reassignment NPD
• Foot and Ankle Center of Augusta

  • Podiatrist
  • Augusta, GA
  • NPI 1922272012
  NPD (past) Authorized official
• Aiyan Diabetes Center Inc

  • Podiatrist
  • Augusta, GA
  • NPI 1568748978
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1275643710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 CENTRAL AVE.",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309045850",
            "telephone_number": "706-373-4402",
            "fax_number": "706-364-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 CENTRAL AVE.",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309045850",
            "telephone_number": "706-373-4402",
            "fax_number": "706-364-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FYNE",
        "first_name": "LATANYA",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "000619",
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "GA",
            "license": "000619",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPD619",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jade Elizabeth Funck, DO
• Rachel Funderburg
• Kung-Hsi Fung, M.D.
• Alan Richard Furness, DMD
• Fyne Foot Care Center
• G. Wilson Enterprise,Inc. (The Medicine Shoppe Pharmacy #1774)
• G.B. Hill & Company (G.B. Hill Medical Supply)
• G.R.a.Y.S. Group, LLC
• G.R.a.Y.S. Group, LLC
• Ga Department of Human Resources (East Central Regional Hospital)

• Podiatrist in Augusta, GA
• Providers in Augusta, GA by specialty
• Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.