Provider Demographics
NPI:1558562579
Name:INTERNATIONAL CENTER FOR FOOT & ANKLE SURGERY
Entity Type:Organization
Organization Name:INTERNATIONAL CENTER FOR FOOT & ANKLE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE- PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-487-6716
Mailing Address - Street 1:1975 HIGHWAY 54 W
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4747
Mailing Address - Country:US
Mailing Address - Phone:770-487-6716
Mailing Address - Fax:770-487-1232
Practice Address - Street 1:7130 MOUNT ZION BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2566
Practice Address - Country:US
Practice Address - Phone:770-716-2685
Practice Address - Fax:770-716-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical