Provider Demographics
NPI:1811239486
Name:MOBILE PODIATRY LLC
Entity Type:Organization
Organization Name:MOBILE PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HIMMELSBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-395-5089
Mailing Address - Street 1:535 CHASERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8326
Mailing Address - Country:US
Mailing Address - Phone:706-395-5089
Mailing Address - Fax:
Practice Address - Street 1:535 CHASERIDGE DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8326
Practice Address - Country:US
Practice Address - Phone:706-395-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty