Organization
MARIETTA PODIATRY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLYN E. LEWIS DPM (CEO)
(770) 422-9856
Entity
Organization
Contact information
Practice address
165 VANN ST NE, MARIETTA, GA 30060-7249
(770) 422-9856
(770) 984-0303
Mailing address
165 VANN ST NE, MARIETTA, GA 30060-7249
(770) 422-9856
(770) 984-0303
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
GA
332BC3200X
Customized Equipment (DME)
—
GA
Other
Enumeration date
03/19/2007
Last updated
01/05/2012
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