Healthcare Provider Details

I. General information

NPI: 1417511700
Provider Name (Legal Business Name): LANIER FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 EE BUTLER PKWY FL 1
GAINESVILLE GA
30501-4524
US

IV. Provider business mailing address

447 EE BUTLER PKWY FL 1
GAINESVILLE GA
30501-4524
US

V. Phone/Fax

Practice location:
  • Phone: 770-796-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGORY SUTTON
Title or Position: OWNER
Credential:
Phone: 770-796-0005