Provider Demographics
NPI:1184056897
Name:TROTTER, MINDY JEAN (DPM)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:JEAN
Last Name:TROTTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:770-487-6716
Mailing Address - Fax:770-487-7721
Practice Address - Street 1:1975 HIGHWAY 54 W STE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4794
Practice Address - Country:US
Practice Address - Phone:770-487-6716
Practice Address - Fax:770-487-7721
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001215213ES0103X, 213ES0103X
IL016005638213ES0103X
IA073684213ES0103X
IA076384213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF300274249Medicare PIN
IAIB3247Medicare UPIN