Healthcare Provider Details

I. General information

NPI: 1427229475
Provider Name (Legal Business Name): AFFILIATED FOOT AND ANKLE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 MAPLE DR NE STE 2
ATLANTA GA
30305-2618
US

IV. Provider business mailing address

3071 PEACHTREE INDUSTRIAL BLVD STE 110
DULUTH GA
30097-8607
US

V. Phone/Fax

Practice location:
  • Phone: 404-231-1227
  • Fax: 404-364-0834
Mailing address:
  • Phone: 770-232-9778
  • Fax: 770-232-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD000966
License Number StateGA

VIII. Authorized Official

Name: DR. ANNETTE D FILLIATRAULT
Title or Position: PHYSICIAN/CEO
Credential: DPM
Phone: 404-231-1227