Healthcare Provider Details

I. General information

NPI: 1841747359
Provider Name (Legal Business Name): ATLANTIC FOOT AND ANKLE SPECISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CANAL ST STE 702
POOLER GA
31322-4291
US

IV. Provider business mailing address

114 CANAL ST STE 703
POOLER GA
31322-4291
US

V. Phone/Fax

Practice location:
  • Phone: 912-988-3323
  • Fax: 912-988-3612
Mailing address:
  • Phone: 912-988-3323
  • Fax: 912-988-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MELISSA ROBITAILLE
Title or Position: OWNER
Credential: DPM
Phone: 912-988-3323