Provider Demographics
NPI:1932393253
Name:ASSOCIATED FOOT & ANKLE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:ASSOCIATED FOOT & ANKLE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-483-2291
Mailing Address - Street 1:1567 MILSTEAD RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3835
Mailing Address - Country:US
Mailing Address - Phone:770-483-2291
Mailing Address - Fax:770-483-2927
Practice Address - Street 1:1567 MILSTEAD RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3835
Practice Address - Country:US
Practice Address - Phone:770-483-2291
Practice Address - Fax:770-483-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000702213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480016118OtherRAILROAD MEDICARE
GA300030892AMedicaid
151680414523OtherHUMANA
=========OtherCIGNA
GA480016118OtherRAILROAD MEDICARE
GA300030892AMedicaid
GA1051500001Medicare NSC