Provider Demographics
NPI:1528178530
Name:VILLAGE PODIATRY GROUP, P.C.
Entity Type:Organization
Organization Name:VILLAGE PODIATRY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:300 VILLAGE GREEN CIR SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3476
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:770-874-2496
Practice Address - Street 1:2850 HOG MOUNTAIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1012
Practice Address - Country:US
Practice Address - Phone:404-446-1940
Practice Address - Fax:404-446-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2066OtherMEDICARE GROUP NUMBER