Healthcare Provider Details

I. General information

NPI: 1164835005
Provider Name (Legal Business Name): ELENI ANDRIA FOOTMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 HUGH HOWELL RD STE D
TUCKER GA
30084-4905
US

IV. Provider business mailing address

4424 HUGH HOWELL RD STE D
TUCKER GA
30084-4905
US

V. Phone/Fax

Practice location:
  • Phone: 404-692-4466
  • Fax: 415-252-7176
Mailing address:
  • Phone: 404-692-4466
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116027044
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80705
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101261415
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: