Genesis Foot & Leg Specialists, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

625 Issued in SC

Legal business name

GENESIS FOOT & LEG SPECIALISTS, LLC

Practice address

21563 Wyhte Hardee Blvd
Hardeeville, SC 29927

Phone

(912) 777-6519

Fax

(912) 777-6584

NPI assigned

Mar 14, 2014

Last updated

Mar 14, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Davis

Title

Credentialing Specialists

Phone

(912) 777-6519

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394755200000",
    "number": "1952727992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 EAST 65TH STREET",
            "address_2": "UNIT 34",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31404",
            "telephone_number": "912-777-6519",
            "fax_number": "912-777-6584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21563 WYHTE HARDEE BLVD",
            "city": "HARDEEVILLE",
            "state": "SC",
            "postal_code": "29927",
            "telephone_number": "912-777-6519",
            "fax_number": "912-777-6584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS FOOT & LEG SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-14",
        "last_updated": "2014-03-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALISTS",
        "authorized_official_telephone_number": "912-777-6519"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "SC",
            "license": "625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPD625",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Hardeeville, SC
• Providers in Hardeeville, SC by specialty
• Foot & Ankle Surgery Podiatrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.