MEDICARE: FOOT DYNAMICS INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	174400000X	Specialist		GA

General Provider Information

NPI Number	:	1336355577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT DYNAMICS INC

Provider Business Mailing Address
First Line	:	51 CHERT RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-3629
Country	:	US
Telephone Number	:	770-582-1122
Fax Number	:	770-582-1133

Provider Business Practice Location Address
First Line	:	2030 POWERS FERRY RD SE STE 540
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5032
Country	:	US
Telephone Number	:	770-582-1122
Fax Number	:	770-582-1133

Authorized Official
Title or Position	:	CEO
Name	:	RICARDO MARTINEZ
Credential	:	CPED
Telephone Number	:	678-468-7463

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	02/25/2025

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Directions to “FOOT DYNAMICS INC ” Practice Location

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