MEDICARE: PODIATRY CARE OF GEORGIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	000931	GA

General Provider Information

NPI Number	:	1871929893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY CARE OF GEORGIA

Provider Business Mailing Address
First Line	:	415 ARMOUR DR NE
Second Line	:	3103
City	:	ATLANTA
State	:	GA
Zip	:	30324-3933
Country	:	US
Telephone Number	:	404-904-3773
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 ARMOUR DR NE
Second Line	:	3103
City	:	ATLANTA
State	:	GA
Zip	:	30324-3933
Country	:	US
Telephone Number	:	404-904-3773
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RONDRICK WILLIAMSON
Credential	:	DPM
Telephone Number	:	404-904-3773

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	09/23/2013

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