Provider Demographics
NPI:1356598593
Name:PROVIDENCE FOOT & ANKLE CENTERS PC
Entity type:Organization
Organization Name:PROVIDENCE FOOT & ANKLE CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ATKINSON-SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-745-4224
Mailing Address - Street 1:3886 PRINCETON LAKES WAY SW
Mailing Address - Street 2:SUITE 140A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5511
Mailing Address - Country:US
Mailing Address - Phone:770-745-4224
Mailing Address - Fax:770-790-4752
Practice Address - Street 1:1110 MARSHALL RD
Practice Address - Street 2:WELLNESS CENTER
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4216
Practice Address - Country:US
Practice Address - Phone:866-896-3338
Practice Address - Fax:770-790-4752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE FOOT & ANKLE CENTERS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-19
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9277OtherMEDICARE GROUP PTAN FOR SC (PALMETTO GBA)
SCDQ9090OtherMEDICARE RR (PALMETTO GBA) SC
SCPENDINGOtherDME (PALMETTO GBA NSC) GROUP PTAN