1891887311 NPI number — VILLAGE PODIATRY GROUP, LLC.

Table of content: (NPI 1891887311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891887311 NPI number — VILLAGE PODIATRY GROUP, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE PODIATRY GROUP, 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:
1891887311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 CIRCLE 75 PKWY.
Provider Second Line Business Mailing Address:
STE. 900
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-3084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-384-0284
Provider Business Mailing Address Fax Number:
770-432-7638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3655 HOWELL FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30096-3186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-497-8283
Provider Business Practice Location Address Fax Number:
770-497-8285
Provider Enumeration Date:
09/29/2006

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: CL1536 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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