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General NPI Number Information
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NPI Number | 1760649602
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Entity Type | Individual
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Provider Name | RYAN HUDSON FITZGERALD DPM
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Gender | Male
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 132 RIVERSTONE TER STE 101
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City | CANTON
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State | GA
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Zip | 30114
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Country | US
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Telephone | 678-880-0036
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Fax | 404-481-4427
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Provider Business Mailing Address
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Address Line | 900 CIRCLE 75 PKWY SE STE 900
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City | ATLANTA
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State | GA
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Zip | 30339-3084
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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 |
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Name |
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Credential |
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Telephone |
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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 | 626
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103301013
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD001364
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License Number State | GA
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