Provider Demographics
NPI:1306323738
Name:STRIDE FOOT & ANKLE CENTER, LLC
Entity type:Organization
Organization Name:STRIDE FOOT & ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:I
Authorized Official - Last Name:MAYEMBE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:678-288-9205
Mailing Address - Street 1:4950 GLADSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6945
Mailing Address - Country:US
Mailing Address - Phone:678-288-9205
Mailing Address - Fax:678-926-3550
Practice Address - Street 1:4775 JIMMY CARTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3760
Practice Address - Country:US
Practice Address - Phone:678-694-8407
Practice Address - Fax:678-694-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-28
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty