Healthcare Provider Details

I. General information

NPI: 1265735377
Provider Name (Legal Business Name): VILLAGE PODIATRY GROUP, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 RIVERSTONE TER STE 101
CANTON GA
30114-1703
US

IV. Provider business mailing address

900 CIRCLE 75 PKWY. STE. 900
ATLANTA GA
30339-3084
US

V. Phone/Fax

Practice location:
  • Phone: 678-880-0036
  • Fax:
Mailing address:
  • Phone: 770-384-0284
  • Fax: 404-446-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DAVID N. HELFMAN
Title or Position: C.E.O.
Credential: D.P.M.
Phone: 770-384-0284