=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073586715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLCOMBS FOOT AND LEG CLINICS OF CUMMING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 97 HEFNER ST STE 202
-----------------------------------------------------
City | ELLIJAY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-880-0036
-----------------------------------------------------
Fax | 678-493-7051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 236 ATLANTA ROAD
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-889-9596
-----------------------------------------------------
Fax | 770-889-9547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRET J HINTZE
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 770-889-9596
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 000925
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------