Provider Demographics
NPI:1689058174
Name:INSTEP PODIATRY, LLC
Entity Type:Organization
Organization Name:INSTEP PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:678-718-5835
Mailing Address - Street 1:4045 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE D-17; PMB 248
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2538
Mailing Address - Country:US
Mailing Address - Phone:678-718-5835
Mailing Address - Fax:770-790-0054
Practice Address - Street 1:5385 FIVE FORKS TRICKUM RD
Practice Address - Street 2:SUITE F
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3018
Practice Address - Country:US
Practice Address - Phone:678-718-5835
Practice Address - Fax:770-790-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001061213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty