Provider Demographics
NPI:1174727119
Name:GEORGIA FOOT & ANKLE PC
Entity type:Organization
Organization Name:GEORGIA FOOT & ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-786-0070
Mailing Address - Street 1:3160 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2461
Mailing Address - Country:US
Mailing Address - Phone:770-786-0070
Mailing Address - Fax:770-786-9744
Practice Address - Street 1:3160 ELM STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2461
Practice Address - Country:US
Practice Address - Phone:770-786-0070
Practice Address - Fax:770-786-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADPM000747213ES0103X
GAPOD000952213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00746611AMedicaid
GAGRP2506Medicare PIN
GA48SCBQJMedicare ID - Type Unspecified
GAU59111Medicare UPIN
GA0947480001Medicare NSC