1467644880 NPI number — FOCUS FOOT & ANKLE CENTERS, 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 1467644880 NPI number — FOCUS FOOT & ANKLE CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOCUS FOOT & ANKLE CENTERS, 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:
6
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:
1467644880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5491 ROSWELL RD NE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-252-6662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5491 ROSWELL RD NE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-252-6662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PITTS
Authorized Official First Name:
JON
Authorized Official Middle Name:
DARRYL
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
404-252-6662

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  POD000877 , 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: 00838131C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRP 3733 . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com