Organization
GEORGIA RECONSTRUCTIVE FOOT AND ANKLE CENTER LLC
Active
Other names
Georgia Reconstructive Foot and Ankle
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL ALAN HANSON DPM (OWNER)
(678) 770-5838
Entity
Organization
Contact information
Practice address
293 N BROAD ST, WINDER, GA 30680-2155
(770) 867-4110
Mailing address
293 N BROAD ST, WINDER, GA 30680-2155
(770) 867-4110
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001293
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
POD001293
LICENSE
GA
Enumeration date
04/06/2016
Last updated
12/12/2016
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