1093364028 NPI number — ANKLE AND FOOT CENTERS OF GEORGIA, LLC

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 1093364028 NPI number — ANKLE AND FOOT CENTERS OF GEORGIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANKLE AND FOOT CENTERS OF GEORGIA, LLC
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:
1093364028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1975 HIGHWAY 54 W STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEACHTREE CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30269-4794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-561-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 WINDY HILL RD SE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067-8650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-902-0456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
KETAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGING MEMBER
Authorized Official Telephone Number:
678-561-9000

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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