Healthcare Provider Details

I. General information

NPI: 1093243024
Provider Name (Legal Business Name): GAIT MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 N DESERT DR STE 112
EAST POINT GA
30344-5724
US

IV. Provider business mailing address

3485 N DESERT DR STE 112
EAST POINT GA
30344-5724
US

V. Phone/Fax

Practice location:
  • Phone: 215-740-7000
  • Fax: 770-790-4752
Mailing address:
  • Phone: 215-740-7000
  • Fax: 770-790-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberPOD000948
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD000948
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number602
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberPOD000948
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD000948
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number602
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPOD000948
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number602
License Number StateSC
# 9
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD000948
License Number StateGA

VIII. Authorized Official

Name: DR. ADRIENNE ATKINSON-SNEED
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 215-740-7000