Healthcare Provider Details

I. General information

NPI: 1356598593
Provider Name (Legal Business Name): PROVIDENCE FOOT & ANKLE CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MARSHALL RD WELLNESS CENTER
GREENWOOD SC
29646-4216
US

IV. Provider business mailing address

3886 PRINCETON LAKES WAY SW SUITE 140A
ATLANTA GA
30331-5511
US

V. Phone/Fax

Practice location:
  • Phone: 866-896-3338
  • Fax: 770-790-4752
Mailing address:
  • Phone: 770-745-4224
  • Fax: 770-790-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ADRIENNE M. ATKINSON-SNEED
Title or Position: CEO
Credential: D.P.M.
Phone: 770-745-4224