Healthcare Provider Details

I. General information

NPI: 1255642609
Provider Name (Legal Business Name): ERINN NICOLE PONDER D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERINN N PONDER ERINNNPONDERWILLIAMS

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 ASHFORD DUNWOODY RD UNIT 467486
ATLANTA GA
30338-5503
US

IV. Provider business mailing address

4707 ASHFORD DUNWOODY RD UNIT 467486
ATLANTA GA
30338-5503
US

V. Phone/Fax

Practice location:
  • Phone: 470-588-5477
  • Fax: 470-200-3627
Mailing address:
  • Phone: 470-588-5477
  • Fax: 470-200-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3614
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number001238
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: