Provider Demographics
NPI:1336355577
Name:FOOT DYNAMICS INC
Entity type:Organization
Organization Name:FOOT DYNAMICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:678-468-7463
Mailing Address - Street 1:51 CHERT RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3629
Mailing Address - Country:US
Mailing Address - Phone:770-582-1122
Mailing Address - Fax:770-582-1133
Practice Address - Street 1:2030 POWERS FERRY RD SE STE 540
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5032
Practice Address - Country:US
Practice Address - Phone:770-582-1122
Practice Address - Fax:770-582-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5136870001Medicare NSC