MEDICARE: ELDRIDGE PODIATRY AND DIABETES CENTER, 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	261QP1100X	Podiatric Clinic/Center	001267	GA

General Provider Information

NPI Number	:	1508384892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDRIDGE PODIATRY AND DIABETES CENTER, LLC

Provider Business Mailing Address
First Line	:	1000 BARONE AVE NE APT 6308
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-1871
Country	:	US
Telephone Number	:	205-422-6419
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 DANNON VW SW STE 2201
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2156
Country	:	US
Telephone Number	:	404-736-7198
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHEREE SHANTELL ELDRIDGE
Credential	:	DPM
Telephone Number	:	404-736-7198

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	07/21/2022

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