Provider Demographics
NPI:1265789424
Name:PREMIER PODIATRY, INC
Entity type:Organization
Organization Name:PREMIER PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONNICA
Authorized Official - Middle Name:SHENEA
Authorized Official - Last Name:DOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-794-9284
Mailing Address - Street 1:656 EXCHANGE CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-1763
Mailing Address - Country:US
Mailing Address - Phone:678-963-5950
Mailing Address - Fax:678-963-0342
Practice Address - Street 1:656 EXCHANGE CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-1763
Practice Address - Country:US
Practice Address - Phone:678-963-5950
Practice Address - Fax:678-963-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1099261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G700927Medicare UPIN