Provider Demographics
NPI:1508441395
Name:SOLES TO HEEL FOOT AND ANKLE, LLC
Entity Type:Organization
Organization Name:SOLES TO HEEL FOOT AND ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MATRECE
Authorized Official - Last Name:GREEN-WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-844-4499
Mailing Address - Street 1:310 COLLEGIATE DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4333
Mailing Address - Country:US
Mailing Address - Phone:407-844-4499
Mailing Address - Fax:777-738-3007
Practice Address - Street 1:1899 LAKE RD STE 210
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2293
Practice Address - Country:US
Practice Address - Phone:678-742-8433
Practice Address - Fax:770-738-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty