1578537247 NPI number — WINDY HILL PODIATRY ASSOCIATES, P.C.

Table of content: (NPI 1578537247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578537247 NPI number — WINDY HILL PODIATRY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDY HILL PODIATRY ASSOCIATES, 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:
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:
1578537247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2020
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:
678-902-0457
Provider Business Mailing Address Fax Number:
770-952-5300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 WINDY HILL RD SE
Provider Second Line Business Practice Location Address:
SUIT 105
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067-8664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-952-0868
Provider Business Practice Location Address Fax Number:
770-952-5300
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
KETAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAN/OWNER
Authorized Official Telephone Number:
678-561-9000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  033-067 , 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: 00534916B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com