1801939293 NPI number — GEORGIA FOOT & ANKLE SPECIALISTS

Table of content: (NPI 1801939293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801939293 NPI number — GEORGIA FOOT & ANKLE SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA FOOT & ANKLE SPECIALISTS
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:
Provider Other Organization Name Type Code:
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:
1801939293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 W 10TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30165-2640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-232-3888
Provider Business Mailing Address Fax Number:
706-232-8099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 MARTHA BERRY BLVD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30165-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-232-3888
Provider Business Practice Location Address Fax Number:
877-795-8359
Provider Enumeration Date:
02/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAPOINTE
Authorized Official First Name:
STEPHAN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-232-3888

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  POD000831 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: POD000831 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: POD000831 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 241085277A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".