Organization
SOUTHWEST ATLANTA PODIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICIA W BENNETT DPM (CEO)
(973) 243-2666
Entity
Organization
Contact information
Practice address
3915 CASCADE RD SW, SUITE 230, ATLANTA, GA 30331-8512
(973) 243-2666
Mailing address
3915 CASCADE RD SW, ATLANTA, GA 30331-8512
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
POD 1031
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5551005
—
NJ
Enumeration date
01/30/2015
Last updated
01/30/2015
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