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General NPI Number Information
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NPI Number | 1184292138
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Entity Type | Organization
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Legal Business Name | SUWANEE FOOT AND ANKLE SPECIALISTS LLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 1300 PEACHTREE INDUSTRIAL BLVD STE 4105
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City | SUWANEE
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State | GA
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Zip | 30024-4541
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Country | US
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Telephone | 470-589-1204
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Fax | 470-589-1465
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Provider Business Mailing Address
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Address Line | 1300 PEACHTREE INDUSTRIAL BLVD STE 4105
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City | SUWANEE
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State | GA
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Zip | 30024-4541
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Country | US
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Telephone | 470-589-1204
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Fax | 470-589-1465
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TOMMY LEE TALLY JR.
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Credential | DPM
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Telephone | 470-589-1204
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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 |
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License Number State |
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