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General NPI Number Information
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NPI Number | 1326594888
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Entity Type | Organization
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Legal Business Name | 26 MEDICAL, LLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 202 INSPERON DR STE 202
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City | GROVETOWN
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State | GA
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Zip | 30813-0602
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Country | US
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Telephone | 706-597-0102
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Fax | 706-257-0258
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Provider Business Mailing Address
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Address Line | 6350 LAKE OCONEE PKWY STE 110
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City | GREENSBORO
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State | GA
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Zip | 30642-6490
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Country | US
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Telephone | 706-597-0102
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Fax | 706-257-0258
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | HOPE SPIVEY
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Credential |
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Telephone | 706-597-0102
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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 | POD001056
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License Number State | GA
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