NPIMap

Organization Active NPI

West Georgia Podiatry Assoc.

  • Foot & Ankle Surgery Podiatrist
  • Carrollton, GA
National Provider Identifier
1013061357
Registry record updated Jan 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
000478 Issued in GA
Legal business name
WEST GEORGIA PODIATRY ASSOC.
Practice address
125 History Dr
Carrollton, GA 30117-3969
Phone
(770) 832-3546
Fax
(770) 832-3518
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judy M Harris
Title
Practice Administrator
Phone
(770) 832-3546

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X 000434 GA
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X 000758 GA
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X 000478 GA Primary

Addresses

Primary practice location

125 History Dr
Carrollton, GA 30117-3969

Mailing address

125 History Dr
Carrollton, GA 30117-3969
Phone (770) 832-3546

Other identifiers 2

IdentifierTypeStateIssuer
000672306AMedicaidGA
000133834AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040506000517 GA Part B Supplier - Clinic/Group Practice 2961490941 Receives reassigned benefits from 3 practitioners
Practice locations: Carrollton, GA
O20100930085162 GA DME Supplier - Physician - Podiatry 2961490941 Practice locations: Carrollton, GA

National Provider Directory

National Provider Directory

Locations

125 History Dr
Carrollton, GA 30117
Phone (770) 832-3546

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199664000000",
    "number": "1013061357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 HISTORY DR",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173969",
            "telephone_number": "770-832-3546",
            "fax_number": "770-832-3518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HISTORY DR",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173969",
            "telephone_number": "770-832-3546",
            "fax_number": "770-832-3518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST GEORGIA PODIATRY ASSOC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2008-01-07",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-832-3546"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "000434",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "000758",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "000478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000672306A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000133834A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.