Healthcare Provider Details

I. General information

NPI: 1013038587
Provider Name (Legal Business Name): FISHER FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 NORTH TENNESSEE ST SUITE 104
CARTERSVILLE GA
30120-7938
US

IV. Provider business mailing address

1124 NORTH TENNESSEE ST SUITE 104
CARTERSVILLE GA
30120-7938
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-4111
  • Fax: 770-386-4905
Mailing address:
  • Phone: 770-386-4111
  • Fax: 770-386-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000939
License Number StateGA

VIII. Authorized Official

Name: DR. DANA JUSTINE FISHER
Title or Position: OWNER/PRACTITIONER
Credential: D.P.M.
Phone: 770-386-4111