Healthcare Provider Details

I. General information

NPI: 1336355577
Provider Name (Legal Business Name): FOOT DYNAMICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 POWERS FERRY RD SE STE 540
ATLANTA GA
30339-5032
US

IV. Provider business mailing address

51 CHERT RD
MARIETTA GA
30062-3629
US

V. Phone/Fax

Practice location:
  • Phone: 770-582-1122
  • Fax: 770-582-1133
Mailing address:
  • Phone: 770-582-1122
  • Fax: 770-582-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RICARDO MARTINEZ
Title or Position: CEO
Credential: CPED
Phone: 678-468-7463