Provider Demographics
NPI:1699112730
Name:VILLAGE PODIATRY GROUP, LLC.
Entity type:Organization
Organization Name:VILLAGE PODIATRY GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:HELFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-384-0284
Mailing Address - Street 1:900 CIRCLE 75 PKWY.
Mailing Address - Street 2:STE. 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:4749 NELSON BROGDON BLVD.
Practice Address - Street 2:BLDG 300 STE 101
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-7524
Practice Address - Country:US
Practice Address - Phone:770-614-5554
Practice Address - Fax:770-932-2752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTREMITY HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-30
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1103400039Medicare NSC