Provider Demographics
NPI:1700246055
Name:PODIATRIC PHYSICIANS OF GEORGIA PC
Entity Type:Organization
Organization Name:PODIATRIC PHYSICIANS OF GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LAWANA
Authorized Official - Last Name:NORVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-470-5338
Mailing Address - Street 1:2575 SNAPFINGER RD STE D
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2300
Mailing Address - Country:US
Mailing Address - Phone:770-981-6940
Mailing Address - Fax:770-981-1273
Practice Address - Street 1:2575 SNAPFINGER RD STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034
Practice Address - Country:US
Practice Address - Phone:770-981-6940
Practice Address - Fax:770-981-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001107213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty