Organization
S.DEKALB FOOT & ANKLE SURGICAL CTR
Active
Organization
S.DEKALB FOOT & ANKLE SURGICAL CTR
Active
Other names
FAMILY FOOT & ANKLE CTR
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER PETER THEODORE DPM (PODIATRIST)
(404) 241-7848
Entity
Organization
Contact information
Practice address
841 MULBERRY ST, MACON, GA 31201-6756
(478) 741-1192
(478) 741-0029
Mailing address
2889 S RAINBOW DR, SUITE C, DECATUR, GA 30034-1670
(404) 241-7848
(404) 241-2161
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
000753
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00655322A
—
GA
Enumeration date
06/25/2007
Last updated
08/22/2020
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