Provider Demographics
NPI:1932274008
Name:ANKLE AND FOOT CENTERS INC
Entity type:Organization
Organization Name:ANKLE AND FOOT CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-977-3668
Mailing Address - Street 1:2790 SANDY PLAINS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4378
Mailing Address - Country:US
Mailing Address - Phone:770-977-3668
Mailing Address - Fax:770-578-0033
Practice Address - Street 1:2790 SANDY PLAINS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4378
Practice Address - Country:US
Practice Address - Phone:770-977-3668
Practice Address - Fax:770-578-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000926213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1296150001Medicare NSC