Provider Demographics
NPI:1053583666
Name:CHOICE PODIATRY CENTER, INC.
Entity type:Organization
Organization Name:CHOICE PODIATRY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:CHEREE
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-702-8723
Mailing Address - Street 1:540 POWDER SPRINGS ST STE B6
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3559
Mailing Address - Country:US
Mailing Address - Phone:770-702-8723
Mailing Address - Fax:770-702-8809
Practice Address - Street 1:540 POWDER SPRINGS ST STE B6
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3559
Practice Address - Country:US
Practice Address - Phone:770-702-8723
Practice Address - Fax:707-702-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001071213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00460780OtherRAILROAD MEDICARE
GAP00460780OtherRAILROAD MEDICARE
GA48SCCWRMedicare PIN