Organization
MODERN PODIATRY, LLC
Active
Organization
MODERN PODIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIBIBI WANZU DPM (OWNER)
(470) 781-5585
Entity
Organization
Contact information
Practice address
730 S 8TH ST, GRIFFIN, GA 30224-4827
(770) 228-6644
(770) 228-5769
Mailing address
730 S 8TH ST, GRIFFIN, GA 30224-4827
(770) 228-6644
(770) 228-5769
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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