MEDICARE: DR. CHRISTOPHER RUSSEL CORWIN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	POD001012	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003850983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER RUSSEL CORWIN DPM

Provider Business Mailing Address
First Line	:	900 CIRCLE 75 PKWY.
Second Line	:	STE. 900
City	:	ATLANTA
State	:	GA
Zip	:	30339-3084
Country	:	US
Telephone Number	:	678-426-2171
Fax Number	:	404-446-1957

Provider Business Practice Location Address
First Line	:	11459 JOHNS CREEK PKWY.
Second Line	:	STE. 260
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-3515
Country	:	US
Telephone Number	:	770-232-5030
Fax Number	:	770-495-9993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/19/2019

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