Provider Demographics
NPI:1962922039
Name:GAIT MEDICAL LLC
Entity type:Organization
Organization Name:GAIT MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON-SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-740-7000
Mailing Address - Street 1:3485 NORTH DESERT DRIVE
Mailing Address - Street 2:SUITE 112 BUILDING 2
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344
Mailing Address - Country:US
Mailing Address - Phone:215-740-7000
Mailing Address - Fax:770-790-4752
Practice Address - Street 1:1110 MARSHALL RD
Practice Address - Street 2:WELLNESS CENTER-PODIATRY
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:215-740-7000
Practice Address - Fax:770-790-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC602213E00000X, 213EP1101X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9887Medicaid
SCPD6023Medicaid