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Organization
NORTH GA FOOT AND ANKLE SPEC
Active
Organization
NORTH GA FOOT AND ANKLE SPEC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUDOLF W CISCO DPM (OWNER DOCTOR)
(770) 287-0606
Entity
Organization
Contact information
Practice address
1224 SHERWOOD PARK DR NE, GAINESVILLE, GA 30501
(770) 287-0606
Mailing address
1224 SHERWOOD PARK DR NE, GAINESVILLE, GA 30501
(770) 287-0606
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00409274A
—
GA
Enumeration date
01/22/2008
Last updated
01/04/2011
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