Provider Demographics
NPI:1780871251
Name:COMPREHENSIVE FOOT & ANKLE
Entity type:Organization
Organization Name:COMPREHENSIVE FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-921-8800
Mailing Address - Street 1:4705 LAWRENCEVILLE HIGHWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047
Mailing Address - Country:US
Mailing Address - Phone:770-921-8800
Mailing Address - Fax:770-921-8801
Practice Address - Street 1:4705 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE C
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3667
Practice Address - Country:US
Practice Address - Phone:770-921-8800
Practice Address - Fax:770-921-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000918261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000930069KMedicaid