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Organization
EAST COBB FOOT & ANKLE CARE P.C.
Active
Organization
EAST COBB FOOT & ANKLE CARE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK R. LIGHT DPM (OWNER)
(770) 977-8221
Entity
Organization
Contact information
Practice address
4439 ROSWELL RD, MARIETTA, GA 30062-6452
(770) 977-8221
(770) 977-8222
Mailing address
4439 ROSWELL RD, MARIETTA, GA 30062-6452
(770) 977-8221
(770) 977-8222
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
630
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000467618B
—
GA
01
—
005480
BCBS
GA
01
—
480034802
RAILROAD MEDICARE
—
Enumeration date
01/25/2007
Last updated
05/29/2009
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