Provider Demographics
NPI:1598097149
Name:METRO FOOT AND ANKLE CENTERS, PC
Entity Type:Organization
Organization Name:METRO FOOT AND ANKLE CENTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-538-1020
Mailing Address - Street 1:8225 MALL PKWY
Mailing Address - Street 2:STE 230
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6994
Mailing Address - Country:US
Mailing Address - Phone:770-484-9599
Mailing Address - Fax:770-484-9929
Practice Address - Street 1:8225 MALL PKWY
Practice Address - Street 2:STE 230
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6994
Practice Address - Country:US
Practice Address - Phone:334-538-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001101213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty