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General NPI Number Information
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NPI Number | 1457753014
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Entity Type | Organization
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Legal Business Name | ESSENTIAL FOOT AND ANKLE CARE, INC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 285 BOULEVARD NE SUITE 525
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City | ATLANTA
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State | GA
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Zip | 30312-4205
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Country | US
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Telephone | 470-333-8855
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Fax | 866-516-2755
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Provider Business Mailing Address
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Address Line | 5145 ROSEWOOD PL
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City | FAIRBURN
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State | GA
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Zip | 30213-5110
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Country | US
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Telephone | 470-333-8855
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Fax | 866-516-2755
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEANE P WATSON
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Credential | DPM
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Telephone | 470-333-8855
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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 | POD001066
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License Number State | GA
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