MODERN PODIATRY LLC NPI 1811538390

NPI Information

NPI: 1811538390
Provider Name: MODERN PODIATRY, LLC
Classification: Clinic/Center - 261QP1100X
Entity Type: Organization

Specialization: Podiatric

Address:
990 BEAR CREEK BLVD STE E
HAMPTON, GA
ZIP 30228
Phone: (470) 781-5585
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MODERN PODIATRY, LLC is a podiatric clinic center in Hampton, GA. MODERN PODIATRY, LLC NPI is 1811538390. The provider is registered as an organization entity type.

The provider's business location address is:

990 BEAR CREEK BLVD STE E
HAMPTON, GA
ZIP 30228-864
Phone: (470) 781-5585

The provider's authorized official is Kibibi Wanzu .
The authorized official title is Owner and has the following contact phone number (470) 781-5585.

The enumeration date for this NPI number is 10/4/2019 and was last updated on 7/2/2020.

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	261QP1100X	Clinic/Center	Podiatric			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	003233587A	MEDICAID	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: 5/5/2024

NPI Synchronization or Removal

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