Provider Demographics
NPI:1962551952
Name:HERBERT E. KOSMAHL DPM PC
Entity type:Organization
Organization Name:HERBERT E. KOSMAHL DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & SENIOR PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOSMAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-629-1852
Mailing Address - Street 1:795 RED BUD RD NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1966
Mailing Address - Country:US
Mailing Address - Phone:706-629-1852
Mailing Address - Fax:706-629-8004
Practice Address - Street 1:795 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1966
Practice Address - Country:US
Practice Address - Phone:706-629-1852
Practice Address - Fax:706-629-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300028755BMedicaid
GACD0240OtherRAILROAD MEDICARE GROUP #
GA507144OtherBCBS GROUP #
GA507144OtherBCBS GROUP #
GA300028755BMedicaid