Healthcare Provider Details

I. General information

NPI: 1205427267
Provider Name (Legal Business Name): CURE PODIATRY & WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 COOK ST
ROYSTON GA
30662-3932
US

IV. Provider business mailing address

625 COOK ST
ROYSTON GA
30662-3932
US

V. Phone/Fax

Practice location:
  • Phone: 762-444-6035
  • Fax:
Mailing address:
  • Phone: 762-444-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAHAR MAHZOON
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 762-444-6035