Organization
PROVIDENCE FOOT & ANKLE CENTERS, P.C., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIENNE M. ATKINSON-SNEED D.P.M. (C.E.O.)
(770) 745-4224
Entity
Organization
Contact information
Practice address
865 THORNTON RD, SUITE B, LITHIA SPRINGS, GA 30122-2607
(770) 745-4224
(770) 790-4752
Mailing address
3886 PRINCETON LAKES WAY SW, SUITE 140A, ATLANTA, GA 30331-5511
(770) 745-4224
(770) 790-4752
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
213ER0200X
Radiology Podiatrist
—
—
213ES0000X
Sports Medicine Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511G700902
MEDICARE GA (CAHABA GBA) GROUP PTAN
GA
01
—
6169580003
DME (PALMETTO GBA NSC) GROUP PTAN FOR THORNTON
—
01
—
DQ9092
MEDICARE RR (PALMETTO GBA) GROUP PTAN
—
Enumeration date
08/13/2008
Last updated
04/19/2012
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