Provider Demographics
NPI:1619261989
Name:NORTH ATLANTA PDOIATRY GRP, PC
Entity Type:Organization
Organization Name:NORTH ATLANTA PDOIATRY GRP, PC
Other - Org Name:FOOT AND ANKLE CENTERS OF NE GA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-963-5161
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:STE 355
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:770-963-5161
Mailing Address - Fax:678-430-0018
Practice Address - Street 1:11459 JOHNS CREEK PKWY
Practice Address - Street 2:STE 260
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-3515
Practice Address - Country:US
Practice Address - Phone:770-963-5161
Practice Address - Fax:678-430-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0430650004OtherCIGNA GOVERNMENT SERVICES
GACN7503OtherRAILROAD MEDICARE
GA0430650004Medicare NSC
GA0430650004OtherCIGNA GOVERNMENT SERVICES