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Organization
GEORGIA PODIATRY, INC
Active
Organization
GEORGIA PODIATRY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY J STEPHENS (PRACTICE MANAGER)
(678) 310-0540
Entity
Organization
Contact information
Practice address
5205 STILESBORO RD NW STE 205, KENNESAW, GA 30152-7765
(678) 310-0540
(678) 310-0538
Mailing address
5205 STILESBORO RD., SUITE 205, KENNESAW, GA 30152-7760
(678) 310-0540
(678) 310-0538
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000937
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215220090
NPI
—
01
—
1679548168
TRICARE
—
01
—
520666344
BCBS
—
01
—
DR8420
RAILROAD MEDICARE
—
Enumeration date
05/26/2011
Last updated
07/21/2022
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