Organization
ATLANTA FOOT AND LEG CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANLEY KALISH DPM (PRESIDENT)
(770) 477-9535
Entity
Organization
Contact information
Practice address
6911 TARA BLVD, SUITE 101, JONESBORO, GA 30236-1503
(770) 477-9535
(770) 471-7826
Mailing address
6911 TARA BLVD, SUITE 101, JONESBORO, GA 30236-1503
(770) 477-9535
(770) 471-7826
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
000382
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000005981A
—
GA
01
—
0498374
AETNA
GA
01
—
406480318
RAILROAD MEDICARE
GA
Enumeration date
06/30/2005
Last updated
03/06/2009
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