Healthcare Provider Details

I. General information

NPI: 1437311818
Provider Name (Legal Business Name): ACTIVE ANKLE AND FOOT CARE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 STATE BRIDGE RD STE 501
ALPHARETTA GA
30022-7484
US

IV. Provider business mailing address

11180 STATE BRIDGE RD STE 501
ALPHARETTA GA
30022-7484
US

V. Phone/Fax

Practice location:
  • Phone: 404-373-7004
  • Fax: 404-373-7008
Mailing address:
  • Phone: 404-373-7004
  • Fax: 404-373-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberPOD000986
License Number StateGA

VIII. Authorized Official

Name: SNEHA SUTHAR
Title or Position: OWNER
Credential: DPM
Phone: 703-405-7792