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General NPI Number Information
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NPI Number | 1235747031
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Entity Type | Organization
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Legal Business Name | LAWRENCEVILLE FOOT AND ANKLE SPECIALISTS
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 600 PROFESSIONAL DR STE 130
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7638
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Country | US
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Telephone | 770-225-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 600 PROFESSIONAL DR STE 130
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7638
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Country | US
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Telephone | 651-757-7516
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CASSANDRA CORZEALIOUS
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Credential |
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Telephone | 770-255-0434
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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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