Provider Demographics
NPI:1295873636
Name:ATLANTIC FOOT AND ANKLE SPECISTS
Entity type:Organization
Organization Name:ATLANTIC FOOT AND ANKLE SPECISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROBITAILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:912-988-3323
Mailing Address - Street 1:114 CANAL ST STE 703
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4291
Mailing Address - Country:US
Mailing Address - Phone:912-988-3323
Mailing Address - Fax:912-988-3612
Practice Address - Street 1:114 CANAL ST STE 703
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4291
Practice Address - Country:US
Practice Address - Phone:912-988-3323
Practice Address - Fax:912-988-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4785810001Medicare NSC