Organization
GAINESVILLE FOOT AND ANKLE SURGERY CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY LEWIS DANIEL D.P.M. (MEDICAL DIRECTOR)
(770) 536-4702
Entity
Organization
Contact information
Practice address
1975 BEVERLY RD, SUITE-B, GAINESVILLE, GA 30501-2034
(770) 536-4702
(770) 536-9394
Mailing address
1975 BEVERLY RD, SUITE-B, GAINESVILLE, GA 30501-2034
(770) 536-4702
(770) 536-9394
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
069-279
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069-279
STATA LICENSE
GA
01
—
51005007-002
BLUE CROSS-BLUE SHIELD
GA
Enumeration date
11/13/2006
Last updated
07/31/2008
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