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General NPI Number Information
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NPI Number | 1922702034
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Entity Type | Organization
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Legal Business Name | ANKLE FOOT LEG CENTERS INC
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 5555 GLENRIDGE CONNECTOR 5555 GLENRIDGE CONNECTOR
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City | ATLANTA
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State | GA
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Zip | 30342
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Country | US
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Telephone | 202-276-9478
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Fax |
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Provider Business Mailing Address
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Address Line | 2355 CENTERVILLE RD UNIT 13413
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4317
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Country | US
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Telephone | 202-276-9478
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEDRICK M DANIELS
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Credential |
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Telephone | 202-276-9478
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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 |
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License Number State |
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