Provider Demographics
NPI:1649631037
Name:FOOT AND ANKLE INSTITUTE OF GEORGIA
Entity type:Organization
Organization Name:FOOT AND ANKLE INSTITUTE OF GEORGIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-922-8922
Mailing Address - Street 1:1775 PARKER RD SE STE C240
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6679
Mailing Address - Country:US
Mailing Address - Phone:770-922-8922
Mailing Address - Fax:770-922-8922
Practice Address - Street 1:1815 HIGHWAY 138 SE # SR
Practice Address - Street 2:SUITE 600
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2079
Practice Address - Country:US
Practice Address - Phone:770-922-8922
Practice Address - Fax:770-922-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001201213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty