Healthcare Provider Details

I. General information

NPI: 1689149601
Provider Name (Legal Business Name): ATLANTA PREMIER FOOT AND ANKLE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STONEFOREST DR STE 120
WOODSTOCK GA
30189-4881
US

IV. Provider business mailing address

2170 SUGAR MAPLE CV NW
ACWORTH GA
30101-8815
US

V. Phone/Fax

Practice location:
  • Phone: 404-245-4969
  • Fax:
Mailing address:
  • Phone: 140-424-5496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NRUP TOLAT
Title or Position: PODIATRIST
Credential: DPM
Phone: 404-245-4969