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General NPI Number Information
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NPI Number | 1750778932
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Entity Type | Organization
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Legal Business Name | METRO PODIATRISTS LLC
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 315 BOULEVARD NE STE 532
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City | ATLANTA
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State | GA
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Zip | 30312-1266
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Country | US
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Telephone | 770-284-1616
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 451371
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City | ATLANTA
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State | GA
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Zip | 31145-9371
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Country | US
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Telephone | 770-284-1616
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | DR. ROSE-MARY MBIBONG-MABO
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Credential | DPM
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Telephone | 770-284-1616
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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 | POD001234
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License Number State | GA
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