Healthcare Provider Details

I. General information

NPI: 1992003479
Provider Name (Legal Business Name): ANKLE AND FOOT CENTERS OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 HIGHWAY 54 W STE 205 STE 205
PEACHTREE CITY GA
30269-4794
US

IV. Provider business mailing address

1975 HIGHWAY 54 W STE 205 STE 205
PEACHTREE CITY GA
30269-4794
US

V. Phone/Fax

Practice location:
  • Phone: 678-561-9000
  • Fax: 678-854-1977
Mailing address:
  • Phone: 678-561-9000
  • Fax: 678-854-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH D. GIOVINCO
Title or Position: MANAGING PARTNER
Credential: DPM
Phone: 678-561-9000