Provider Demographics
NPI:1750778932
Name:METRO PODIATRISTS LLC
Entity type:Organization
Organization Name:METRO PODIATRISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE-MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MBIBONG-MABO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-284-1616
Mailing Address - Street 1:PO BOX 451371
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31145-9371
Mailing Address - Country:US
Mailing Address - Phone:770-284-1616
Mailing Address - Fax:
Practice Address - Street 1:315 BOULEVARD NE STE 532
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1266
Practice Address - Country:US
Practice Address - Phone:770-284-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001234213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty