Organization
PROVIDENCE FOOT & ANKLE CENTERS, PC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADRIENNE M. ATKINSON-SNEED D.P.M. (CEO)
(215) 740-7000
Entity
Organization
Contact information
Practice address
4109 JIMMY LEE SMITH PKWY, SUITE C, HIRAM, GA 30141-2643
(770) 745-4224
(770) 745-4228
Mailing address
3886 PRINCETON LAKES WAY SW, SUITE 140A, ATLANTA, GA 30331-5511
(770) 745-4224
(770) 745-4228
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
213ER0200X
Radiology Podiatrist
—
—
213ES0000X
Sports Medicine Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511G700902
MEDICARE GROUP PTAN GEORGIA
GA
01
—
DQ9092
RR MEDICARE GROUP NUMBER GEORGIA
GA
Enumeration date
04/25/2012
Last updated
04/25/2012
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