Provider Demographics
NPI:1073070579
Name:FOOT AND ANKLE RECONSTRUCTION OF NORTH GEORGIA P.C
Entity Type:Organization
Organization Name:FOOT AND ANKLE RECONSTRUCTION OF NORTH GEORGIA P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:J
Authorized Official - Last Name:HINTZE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-999-0804
Mailing Address - Street 1:49 GORDON ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1017
Mailing Address - Country:US
Mailing Address - Phone:770-999-0804
Mailing Address - Fax:770-999-0814
Practice Address - Street 1:970 WOODSTOCK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4869
Practice Address - Country:US
Practice Address - Phone:770-999-0804
Practice Address - Fax:770-999-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty