Provider Demographics
NPI:1265629869
Name:FOOT, ANKLE AND LEG SPECIALISTS OF GEORGIA
Entity Type:Organization
Organization Name:FOOT, ANKLE AND LEG SPECIALISTS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-979-1890
Mailing Address - Street 1:1800 TREE LN
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2016
Mailing Address - Country:US
Mailing Address - Phone:770-979-1890
Mailing Address - Fax:770-979-2787
Practice Address - Street 1:1800 TREE LN
Practice Address - Street 2:SUITE 320
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2016
Practice Address - Country:US
Practice Address - Phone:770-979-1890
Practice Address - Fax:770-979-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000509213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU02636Medicare UPIN
GA48SCCJPMedicare PIN
GA48SCCJQMedicare PIN
GAU68084Medicare UPIN