Healthcare Provider Details

I. General information

NPI: 1073076170
Provider Name (Legal Business Name): KALISH FOOT & ANKLE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6911 TARA BLVD STE 101
JONESBORO GA
30236-1503
US

IV. Provider business mailing address

6911 TARA BLVD STE 101
JONESBORO GA
30236-1503
US

V. Phone/Fax

Practice location:
  • Phone: 770-477-9535
  • Fax:
Mailing address:
  • Phone: 770-477-9535
  • 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: ELIZABETH MAYNOR
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 770-477-9535