1467551432 NPI number — NORTH GEORGIA FOOT AND ANKLE CLINIC PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467551432 NPI number — NORTH GEORGIA FOOT AND ANKLE CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH GEORGIA FOOT AND ANKLE CLINIC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOLCOMB'S FOOT & LEG CLINIC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467551432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 GORDON RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30143-7104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-999-0804
Provider Business Mailing Address Fax Number:
770-999-0814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 GORDON RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30143-7104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-999-0804
Provider Business Practice Location Address Fax Number:
770-999-0814
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINTZE
Authorized Official First Name:
BRET
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
770-999-0804

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  00536 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ2536 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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