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General NPI Number Information
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NPI Number | 1013038587
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Entity Type | Organization
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Legal Business Name | FISHER FOOT AND ANKLE
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 1124 NORTH TENNESSEE ST SUITE 104
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City | CARTERSVILLE
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State | GA
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Zip | 30120-7938
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Country | US
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Telephone | 770-386-4111
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Fax | 770-386-4905
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Provider Business Mailing Address
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Address Line | 1124 NORTH TENNESSEE ST SUITE 104
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City | CARTERSVILLE
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State | GA
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Zip | 30120-7938
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Country | US
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Telephone | 770-386-4111
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Fax | 770-386-4905
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | DR. DANA JUSTINE FISHER
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Credential | D.P.M.
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Telephone | 770-386-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000939
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License Number State | GA
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