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General NPI Number Information
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NPI Number | 1811291149
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Entity Type | Organization
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Legal Business Name | PODIATRY GROUP OF GEORGIA, INC
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 3901 ROSWELL RD 340
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City | MARIETTA
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State | GA
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Zip | 30062-6250
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Country | US
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Telephone | 404-806-3731
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Fax | 770-321-0001
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Provider Business Mailing Address
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Address Line | 4880 LOWER ROSWELL RD SUITE 165 PMB 150
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City | MARIETTA
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State | GA
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Zip | 30068-4375
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Country | US
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Telephone | 404-806-3731
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. TAMMY KATHRYN GEPHART
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Credential | D.P.M.
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Telephone | 40408063731
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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 | POD001122
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License Number State | GA
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