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Organization

AGAPE FOOT & ANKLE CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CORLISS LA-SHUNUETTE AUSTIN-HARRIS DPM (PRESIDENT)
(404) 483-9761
Entity
Organization

Contact information

Practice address
3693 WITTENBURG CT, DECATUR, GA 30034-5507
(404) 483-9761
Mailing address
PO BOX 543, FOREST PARK, GA 30298-0543
(404) 483-9761

Taxonomy

Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
POD000689
GA

Other

Enumeration date
04/10/2012
Last updated
04/19/2012
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