Healthcare Provider Details

I. General information

NPI: 1467551432
Provider Name (Legal Business Name): NORTH GEORGIA FOOT AND ANKLE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 GORDON RD SUITE 203
JASPER GA
30143-7104
US

IV. Provider business mailing address

51 GORDON RD SUITE 203
JASPER GA
30143-7104
US

V. Phone/Fax

Practice location:
  • Phone: 770-999-0804
  • Fax: 770-999-0814
Mailing address:
  • Phone: 770-999-0804
  • Fax: 770-999-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00536
License Number StateGA

VIII. Authorized Official

Name: DR. BRET J HINTZE
Title or Position: DOCTOR/OWNER
Credential: D.P.M.
Phone: 770-999-0804