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General NPI Number Information
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NPI Number | 1497278147
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Entity Type | Organization
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Legal Business Name | OPTIMUM FOOT AND ANKLE CENTERS LLC
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 2300 W PARK PLACE BLVD STE 122
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3561
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Country | US
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Telephone | 470-292-7116
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Fax | 678-786-1208
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Provider Business Mailing Address
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Address Line | 2300 W PARK PLACE BLVD STE 122
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3561
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Country | US
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Telephone | 470-207-0700
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Fax | 470-207-0702
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. FELICIA DIANE PIERRE
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Credential | DPM
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Telephone | 404-630-5534
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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 | POD000853
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License Number State | GA
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