Provider Demographics
NPI:1467551432
Name:NORTH GEORGIA FOOT AND ANKLE CLINIC PC
Entity Type:Organization
Organization Name:NORTH GEORGIA FOOT AND ANKLE CLINIC PC
Other - Org Name:HOLCOMB'S FOOT & LEG CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:J
Authorized Official - Last Name:HINTZE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-999-0804
Mailing Address - Street 1:51 GORDON RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-7104
Mailing Address - Country:US
Mailing Address - Phone:770-999-0804
Mailing Address - Fax:770-999-0814
Practice Address - Street 1:51 GORDON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7104
Practice Address - Country:US
Practice Address - Phone:770-999-0804
Practice Address - Fax:770-999-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00536213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ2536OtherMEDICARE RAILROAD
CJ2536OtherMEDICARE RAILROAD
GA0825250001Medicare NSC