Provider Demographics
NPI:1841404480
Name:FOOT & ANKLE OF WEST GEORGIA, P.C.
Entity Type:Organization
Organization Name:FOOT & ANKLE OF WEST GEORGIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BARTLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-327-8819
Mailing Address - Street 1:2000 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8927
Mailing Address - Country:US
Mailing Address - Phone:706-327-8819
Mailing Address - Fax:706-327-3147
Practice Address - Street 1:2000 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-327-8819
Practice Address - Fax:706-327-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000508213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2897Medicaid
GAGRP2897Medicaid