Provider Demographics
NPI:1508624701
Name:PODIATRY ASSOCIATES OF GEORGIA
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:470-808-2724
Mailing Address - Street 1:3150 ROSWELL RD NW APT 1909
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2615
Mailing Address - Country:US
Mailing Address - Phone:470-808-2724
Mailing Address - Fax:
Practice Address - Street 1:3150 ROSWELL RD NW APT 1909
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2615
Practice Address - Country:US
Practice Address - Phone:470-808-2724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty