Organization
ELITE FOOT AND ANKLE SPECIALIST-PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE IVIE EJAIFE-AUSTIN DPM (PODIATRIST)
(678) 360-7939
Entity
Organization
Contact information
Practice address
1468 SPRINGLEAF CIR SE, SMYRNA, GA 30080-2400
(678) 360-7939
Mailing address
1468 SPRINGLEAF CIR SE, SMYRNA, GA 30080-2400
(678) 360-7939
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001084
GA
Other
Enumeration date
04/23/2009
Last updated
04/23/2009
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