Provider Demographics
NPI:1053787515
Name:LAGRANGE FOOT CLINIC PC
Entity type:Organization
Organization Name:LAGRANGE FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WARRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-883-6415
Mailing Address - Street 1:411 S GREENWOOD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3183
Mailing Address - Country:US
Mailing Address - Phone:706-883-6415
Mailing Address - Fax:706-884-2429
Practice Address - Street 1:411 S GREENWOOD ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3183
Practice Address - Country:US
Practice Address - Phone:706-883-6415
Practice Address - Fax:706-884-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000502213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty