Provider Demographics
NPI:1982677621
Name:HOLCOMB'S FOOT & LEG CLINIC OF CUMMING
Entity Type:Organization
Organization Name:HOLCOMB'S FOOT & LEG CLINIC OF CUMMING
Other - Org Name:NORTH GA FOOT & ANKLE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:J
Authorized Official - Last Name:HINTZE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-889-9596
Mailing Address - Street 1:236 ATLANTA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2610
Mailing Address - Country:US
Mailing Address - Phone:770-889-9596
Mailing Address - Fax:770-889-9547
Practice Address - Street 1:620 J L WHITE DR
Practice Address - Street 2:STE 100
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:678-880-0036
Practice Address - Fax:678-493-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000925213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52866606002OtherBCBS
GA5168230004OtherDEMRC
GA48SCCNGMedicare ID - Type Unspecified
GA52866606002OtherBCBS