Provider Demographics
NPI:1437311818
Name:ACTIVE ANKLE AND FOOT CARE SPECIALISTS
Entity Type:Organization
Organization Name:ACTIVE ANKLE AND FOOT CARE SPECIALISTS
Other - Org Name:INGIE EL-KHASHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EL- KHASHAB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-373-7004
Mailing Address - Street 1:11180 STATE BRIDGE RD STE 501
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7484
Mailing Address - Country:US
Mailing Address - Phone:404-373-7004
Mailing Address - Fax:404-373-7008
Practice Address - Street 1:11180 STATE BRIDGE RD STE 501
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7484
Practice Address - Country:US
Practice Address - Phone:404-373-7004
Practice Address - Fax:404-373-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000986305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
6139410001Medicare NSC