Organization
GAINESVILLE PODIATRY CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY LEWIS DANIEL D.P.M. (PRESIDENT)
(770) 536-9908
Entity
Organization
Contact information
Practice address
1975 BEVERLY ROAD, SUITE B, GAINESVILLE, GA 30501-3726
(770) 536-9908
(770) 532-7102
Mailing address
1975 BEVERLY RD, SUITE B, GAINESVILLE, GA 30501-2034
(770) 536-9908
(770) 532-7102
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055002335A
—
GA
Enumeration date
11/13/2006
Last updated
08/26/2008
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