Provider Demographics
NPI:1891886917
Name:COMPREHENSIVE FOOT CARE, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE FOOT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-234-9534
Mailing Address - Street 1:1400 VETERANS MEMORIAL HWY SE
Mailing Address - Street 2:SUITE 134 # 139
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:252 TONY TRL SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3655
Practice Address - Country:US
Practice Address - Phone:404-234-9534
Practice Address - Fax:770-944-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000721213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00630374DMedicaid
GAU49736Medicare UPIN
GA00630374DMedicaid