Provider Demographics
NPI:1194126375
Name:FOOT AND ANKLE HEALTH CENTERS, LLC
Entity type:Organization
Organization Name:FOOT AND ANKLE HEALTH CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VASUDHA
Authorized Official - Middle Name:RANI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:678-871-0876
Mailing Address - Street 1:3925 JOHNS CREEK CT
Mailing Address - Street 2:SUITE C2
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6618
Mailing Address - Country:US
Mailing Address - Phone:678-871-0876
Mailing Address - Fax:678-871-0836
Practice Address - Street 1:3925 JOHNS CREEK CT
Practice Address - Street 2:SUITE C2
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6618
Practice Address - Country:US
Practice Address - Phone:678-871-0876
Practice Address - Fax:678-871-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001248213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7512670001Medicare NSC