MEDICARE: VILLAGE PODIATRY GROUP, LLC

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

General Provider Information

NPI Number	:	1063720274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE PODIATRY GROUP, LLC

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	:	770-384-0284
Fax Number	:	404-446-1957

Provider Business Practice Location Address
First Line	:	3515 DALLAS HWY SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2094
Country	:	US
Telephone Number	:	770-499-0080
Fax Number	:	770-499-0570

Authorized Official
Title or Position	:	C.E.O.
Name	:	DAVID N. HELFMAN
Credential	:	D.P.M.
Telephone Number	:	770-384-0284

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/15/2011

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