Provider Demographics
NPI:1700291069
Name:ATLANTA FAMILY FOOT CARE, LLC
Entity Type:Organization
Organization Name:ATLANTA FAMILY FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBI
Authorized Official - Middle Name:F
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-334-0696
Mailing Address - Street 1:5835 CAMPBELLTON RD SW
Mailing Address - Street 2:STE 201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8013
Mailing Address - Country:US
Mailing Address - Phone:404-334-0696
Mailing Address - Fax:
Practice Address - Street 1:5835 CAMPBELLTON RD SW
Practice Address - Street 2:STE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8013
Practice Address - Country:US
Practice Address - Phone:404-334-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA000972261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1427045319Medicare UPIN