Provider Demographics
NPI:1508846718
Name:VILLAGE PODIATRY GROUP, L.L.C.
Entity Type:Organization
Organization Name:VILLAGE PODIATRY GROUP, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
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 1:1350 UPPER HEMBREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0929
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:1350 UPPER HEMBREE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0929
Practice Address - Country:US
Practice Address - Phone:678-426-2171
Practice Address - Fax:404-446-1957
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTREMITY HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-23
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1103400001Medicare NSC
GA1103400013Medicare NSC
GA1103400014Medicare NSC
GA1103400020Medicare NSC
GA1103400015Medicare NSC
GA1103400017Medicare NSC
GA1103400005Medicare NSC
GA1103400006Medicare NSC
GA1103400008Medicare NSC
GA1103400009Medicare NSC
GA1103400002Medicare NSC
GA1103400007Medicare NSC
GA1103400018Medicare NSC
GA1103400012Medicare NSC
GA1103400016Medicare NSC
GA1103400024Medicare NSC
GAGRP2066Medicare PIN
GA1103400010Medicare NSC