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
1825 HIGHWAY 34 E STE 3410, NEWNAN, GA 30265-6433
(770) 251-8940
(770) 251-5685
Mailing address
1825 HIGHWAY 34 E STE 3410, NEWNAN, GA 30265-6433
(770) 251-8940
(770) 251-5685
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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