Organization · Type 2 NPI
Providence Foot & Ankle Centers, Pc, Inc
Foot & Ankle Surgery Podiatrist · Hiram, GA
NPI number
1083972376
Active
Practice location
4109 Jimmy Lee Smith Pkwy, Suite C
Hiram, GA 30141-2643
Fax (770) 745-4228
Mailing address
3886 Princeton Lakes Way SW, Suite 140A
Atlanta, GA 30331-5511
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist | 213E00000X | None listed |
| Primary Podiatric Medicine Podiatrist | 213EP1101X | None listed |
| Radiology Podiatrist | 213ER0200X | None listed |
| Sports Medicine Podiatrist | 213ES0000X | None listed |
| Foot & Ankle Surgery Podiatrist Primary | 213ES0103X | None listed |
Foot & Ankle Surgery Podiatrist: Definition to come...
About NPI 1083972376
Providence Foot & Ankle Centers, Pc, Inc's National Provider Identifier is 1083972376, issued on Apr 25, 2012. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in Hiram, GA. The record was last updated on Apr 25, 2012.