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General NPI Number Information
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NPI Number | 1467985382
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Entity Type | Organization
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Legal Business Name | VILLAGE PODIATRY GROUP, LLC.
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 2368 BATTLEFIELD PKWY
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4030
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Country | US
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Telephone | 706-861-6200
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Fax | 706-861-6222
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Provider Business Mailing Address
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Address Line | 900 CIRCLE 75 PKWY. SE SUITE 900
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City | ATLANTA
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State | GA
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Zip | 30339-3039
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Country | US
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Telephone | 678-426-2171
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Fax | 404-446-1957
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Authorized Official
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Title or Position | C.O.O.
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Name | MITCHELL P. HILSEN
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Credential | D.P.M.
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Telephone | 678-426-2171
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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 |
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License Number State |
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