Healthcare Provider Details

I. General information

NPI: 1881527539
Provider Name (Legal Business Name): CLINICAL STEPS MOBILE FOOT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5734 WIND GATE LN
LITHONIA GA
30058-2601
US

IV. Provider business mailing address

8170 MALL PKWY # 1114
LITHONIA GA
30038-2545
US

V. Phone/Fax

Practice location:
  • Phone: 470-747-2612
  • Fax:
Mailing address:
  • Phone: 470-747-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARSHA JACKSON
Title or Position: CEO
Credential: RN,BSN,FOOT CARE NUR
Phone: 470-747-2612