Provider Demographics
NPI:1922702034
Name:ANKLE FOOT LEG CENTERS INC
Entity Type:Organization
Organization Name:ANKLE FOOT LEG CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEDRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-276-9478
Mailing Address - Street 1:2355 CENTERVILLE RD UNIT 13413
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4317
Mailing Address - Country:US
Mailing Address - Phone:202-276-9478
Mailing Address - Fax:
Practice Address - Street 1:5555 GLENRIDGE CONNECTOR
Practice Address - Street 2:5555 GLENRIDGE CONNECTOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:202-276-9478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty