Provider Demographics
NPI:1326594888
Name:26 MEDICAL, LLC
Entity Type:Organization
Organization Name:26 MEDICAL, LLC
Other - Org Name:26 FOOT AND ANKLE, GROVETOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-597-0102
Mailing Address - Street 1:6350 LAKE OCONEE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-6490
Mailing Address - Country:US
Mailing Address - Phone:706-597-0102
Mailing Address - Fax:706-257-0258
Practice Address - Street 1:202 INSPERON DR STE 202
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-0602
Practice Address - Country:US
Practice Address - Phone:706-597-0102
Practice Address - Fax:706-257-0258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:26 MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-25
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001056213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1326594888OtherPODIATRY