MEDICARE: AFFILIATED FOOT AND ANKLE, PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	00742	GA

General Provider Information

NPI Number	:	1669452611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATED FOOT AND ANKLE, PC

Provider Business Mailing Address
First Line	:	3071 PEACHTREE INDUSTRIAL BLVD
Second Line	:	STE 110
City	:	DULUTH
State	:	GA
Zip	:	30097-8607
Country	:	US
Telephone Number	:	770-232-9778
Fax Number	:	770-232-9776

Provider Business Practice Location Address
First Line	:	3071 PEACHTREE INDUSTRIAL BLVD
Second Line	:	STE 110
City	:	DULUTH
State	:	GA
Zip	:	30097-8607
Country	:	US
Telephone Number	:	770-232-9778
Fax Number	:	770-232-9776

Authorized Official
Title or Position	:	CFO/TREASURER
Name	:	DR. RICHARD P MISTRETTA
Credential	:	DPM
Telephone Number	:	770-232-9778

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	04/13/2023

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