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General NPI Number Information
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NPI Number | 1306004874
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Entity Type | Organization
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Legal Business Name | BARE FOOT CARE SPECIALIST, LLC
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 3485 ATLANTA HWY
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-2918
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Country | US
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Telephone | 770-531-9222
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Fax |
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Provider Business Mailing Address
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Address Line | 3485 ATLANTA HWY
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-2918
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Country | US
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Telephone | 770-531-9222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEANNETTE VELAZQUEZ
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Credential | DPM
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Telephone | 770-531-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD 1075
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License Number State | GA
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