Provider Demographics
NPI:1922367994
Name:FORSYTH FOOT & ANKLE ASSOCIATES LLC
Entity Type:Organization
Organization Name:FORSYTH FOOT & ANKLE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGLAMRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:678-262-4040
Mailing Address - Street 1:102 MARY ALICE PARK DRIVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2697
Mailing Address - Country:US
Mailing Address - Phone:678-262-4040
Mailing Address - Fax:678-262-4060
Practice Address - Street 1:102 MARY ALICE PARK DRIVE
Practice Address - Street 2:SUITE 502
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2697
Practice Address - Country:US
Practice Address - Phone:678-262-4040
Practice Address - Fax:678-262-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125664AMedicaid
GA003125664AMedicaid
GA202G700137Medicare PIN