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General NPI Number Information
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NPI Number | 1669452611
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Entity Type | Organization
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Legal Business Name | AFFILIATED FOOT AND ANKLE, PC
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 3071 PEACHTREE INDUSTRIAL BLVD STE 110
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City | DULUTH
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State | GA
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Zip | 30097-8607
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Country | US
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Telephone | 770-232-9778
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Fax | 770-232-9776
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Provider Business Mailing Address
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Address Line | 3071 PEACHTREE INDUSTRIAL BLVD STE 110
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City | DULUTH
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State | GA
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Zip | 30097-8607
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Country | US
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Telephone | 770-232-9778
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Fax | 770-232-9776
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Authorized Official
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Title or Position | CFO/TREASURER
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Name | DR. RICHARD P MISTRETTA
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Credential | DPM
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Telephone | 770-232-9778
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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 | 00742
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License Number State | GA
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