Provider Demographics
NPI:1013038587
Name:FISHER FOOT AND ANKLE
Entity Type:Organization
Organization Name:FISHER FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:JUSTINE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-386-4111
Mailing Address - Street 1:1124 NORTH TENNESSEE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-7938
Mailing Address - Country:US
Mailing Address - Phone:770-386-4111
Mailing Address - Fax:770-386-4905
Practice Address - Street 1:1124 NORTH TENNESSEE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-7938
Practice Address - Country:US
Practice Address - Phone:770-386-4111
Practice Address - Fax:770-386-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000939213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5991930001Medicare NSC
GAU96190Medicare UPIN
SC5405470001Medicare NSC