Provider Demographics
NPI:1093739419
Name:VILLAGE PODIATRY GROUP, LLC.
Entity Type:Organization
Organization Name:VILLAGE PODIATRY GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:HELFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-384-0284
Mailing Address - Street 1:900 CIRCLE 75 PKWY.
Mailing Address - Street 2:STE. 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:3825 MEDICAL PARK DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6831
Practice Address - Country:US
Practice Address - Phone:770-745-5101
Practice Address - Fax:770-745-9740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTREMITY HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1103400002Medicare NSC
GAGRP2066Medicare PIN