Healthcare Provider Details

I. General information

NPI: 1790079069
Provider Name (Legal Business Name): NORTH ATLANTA PODIATRY GRP,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2011
Last Update Date: 06/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 GREEN ST
GAINESVILLE GA
30501-3312
US

IV. Provider business mailing address

771 OLD NORCROSS RD STE 355
LAWRENCEVILLE GA
30046-4386
US

V. Phone/Fax

Practice location:
  • Phone: 770-963-5161
  • Fax: 678-430-0018
Mailing address:
  • Phone: 770-963-5161
  • Fax: 678-430-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT I SCHWARTZ
Title or Position: PARTNER
Credential:
Phone: 770-963-5161