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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CL1536	OTHER	GA	RAILROAD MEDICARE GROUP #

General Provider Information

NPI Number	:	1891887311
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	:	770-432-7638

Provider Business Practice Location Address
First Line	:	3655 HOWELL FERRY RD
Second Line	:	SUITE 100
City	:	DULUTH
State	:	GA
Zip	:	30096-3186
Country	:	US
Telephone Number	:	770-497-8283
Fax Number	:	770-497-8285

Authorized Official
Title or Position	:	CEO
Name	:	DAVID N. HELFMAN
Credential	:	DPM
Telephone Number	:	770-384-0284

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	08/19/2014

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