Provider Demographics
NPI:1639553936
Name:LAKE OCONEE FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:LAKE OCONEE FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON J.
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:494-502-9881
Mailing Address - Street 1:1031 VILLAGE PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-3755
Mailing Address - Country:US
Mailing Address - Phone:855-663-8800
Mailing Address - Fax:855-663-8800
Practice Address - Street 1:1031 VILLAGE PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-3755
Practice Address - Country:US
Practice Address - Phone:855-663-8800
Practice Address - Fax:855-663-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty