Provider Demographics
NPI:1689868085
Name:ACHILLES FOOT & ANKLE SPECIALIST
Entity Type:Organization
Organization Name:ACHILLES FOOT & ANKLE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-769-9200
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0012
Mailing Address - Country:US
Mailing Address - Phone:706-769-9200
Mailing Address - Fax:
Practice Address - Street 1:1580 MARS HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4836
Practice Address - Country:US
Practice Address - Phone:706-769-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000585213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 2505OtherMEDICARE GROUP
GAGRP 2505OtherMEDICARE GROUP
GA48SCBQDMedicare PIN