Provider Demographics
NPI:1073852786
Name:ANKLE AND FOOT CLINIC OF GEORGIA, INC.
Entity Type:Organization
Organization Name:ANKLE AND FOOT CLINIC OF GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-460-5064
Mailing Address - Street 1:730 LANIER AVE W
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1509
Mailing Address - Country:US
Mailing Address - Phone:770-460-5064
Mailing Address - Fax:770-460-0838
Practice Address - Street 1:730 LANIER AVE W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1509
Practice Address - Country:US
Practice Address - Phone:770-460-5064
Practice Address - Fax:770-460-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty