Provider Demographics
NPI:1619078276
Name:PRIMARY FOOT & ANKLE CARE
Entity Type:Organization
Organization Name:PRIMARY FOOT & ANKLE CARE
Other - Org Name:TOM DANG
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:TIEN
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-513-3556
Mailing Address - Street 1:862 AMBER HILL CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017
Mailing Address - Country:US
Mailing Address - Phone:770-513-3556
Mailing Address - Fax:770-513-3556
Practice Address - Street 1:862 AMBER HILL CT
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017
Practice Address - Country:US
Practice Address - Phone:770-513-3556
Practice Address - Fax:770-513-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000824213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00771427EMedicaid
GA00771427EMedicaid
U68457Medicare UPIN