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Contact Information

PROVIDENCE FOOT & ANKLE CENTERS, PC, INC
4109 JIMMY LEE SMITH PKWY
SUITE C
HIRAM, GA30141-2643
 Phone: 770-745-4224
 Fax: 770-745-4228
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
 

Podiatrist

213E00000X 48 Podiatry
 

Primary Podiatric Medicine

213EP1101X 48 Podiatry
 

Radiology

213ER0200X 48 Podiatry
 

Sports Medicine

213ES0000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for PROVIDENCE FOOT ANKLE CENTERS PC INC · (Female)

NPI Number 1083972376
Status Active
Credentials
Entity Individual
Enumeration date 04/25/2012
Last updated 04/25/2012 - About 14 years ago
Sole proprietor 1 Not specified
Identifiers
  • GA Other 511G700902 MEDICARE GROUP PTAN GEORGIA
  • GA Other DQ9092 RR MEDICARE GROUP NUMBER GEORGIA
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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