Provider Demographics
NPI:1346240751
Name:ROSWELL CENTER FOR FOOT & ANKLE SURGERY, LLC
Entity Type:Organization
Organization Name:ROSWELL CENTER FOR FOOT & ANKLE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:1357 HEMBREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5710
Mailing Address - Country:US
Mailing Address - Phone:678-990-9851
Mailing Address - Fax:678-990-9869
Practice Address - Street 1:1357 HEMBREE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5710
Practice Address - Country:US
Practice Address - Phone:678-990-9851
Practice Address - Fax:678-990-9869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-378261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11C0001256Medicare ID - Type UnspecifiedASC IDENTIFICATION