1528178530 NPI number — VILLAGE PODIATRY GROUP, P.C.

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 1528178530 NPI number — VILLAGE PODIATRY GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE PODIATRY GROUP, P.C.
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:
1528178530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 VILLAGE GREEN CIR SE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30080-3476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-384-0284
Provider Business Mailing Address Fax Number:
770-874-2496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2850 HOG MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DACULA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30019-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-446-1940
Provider Business Practice Location Address Fax Number:
404-446-1941
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HELFMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-384-0284

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GRP2066 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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