EAST COBB FOOT & ANKLE CARE P.C. NPI 1184770133

NPI Information

NPI: 1184770133
Provider Name: EAST COBB FOOT & ANKLE CARE P.C.
Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

CLIA Number: 11D1037912

Address:
4439 ROSWELL RD
MARIETTA, GA
ZIP 30062
Phone: (770) 977-8221
Get Directions

EAST COBB FOOT & ANKLE CARE P.C. is a foot and ankle surgery podiatrist in Marietta, GA. EAST COBB FOOT & ANKLE CARE P.C. NPI is 1184770133. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4439 ROSWELL RD
MARIETTA, GA
ZIP 30062-452
Phone: (770) 977-8221
Fax: (770) 977-8222

The provider's authorized official is Mark R. Light .
The authorized official title is Owner and has the following contact phone number (770) 977-8221.

The CLIA number assigned to this NPI record is 11D1037912 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/25/2007 and was last updated on 5/29/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	630	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	480034802	OTHER		RAILROAD MEDICARE
2	000467618B	MEDICAID	GEORGIA
3	48SCCLG	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA
4	005480	OTHER	GEORGIA	BCBS
5	4830810001	MEDICARE NSC	GEORGIA
6	U18990	MEDICARE UPIN	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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