MEDICARE: CROSSROADS PODIATRY & INGROWN NAIL CENTER 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	213E00000X	Podiatrist	POD000688	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	POD000688	OTHER	GA	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447331350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS PODIATRY & INGROWN NAIL CENTER INC

Provider Business Mailing Address
First Line	:	3231 HWY 34 EAST
Second Line	:	SUITE C
City	:	NEWNAN
State	:	GA
Zip	:	30265
Country	:	US
Telephone Number	:	770-251-8940
Fax Number	:	770-251-5685

Provider Business Practice Location Address
First Line	:	3231 HWY 34 EAST
Second Line	:	SUITE C
City	:	NEWNAN
State	:	GA
Zip	:	30265
Country	:	US
Telephone Number	:	770-251-8940
Fax Number	:	770-251-5685

Authorized Official
Title or Position	:	OWNER
Name	:	EVERETT J. MASON III
Credential	:	DPM
Telephone Number	:	770-251-8940

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/07/2023

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