MK Podiatry LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

POD001300 Issued in GA

Legal business name

MK PODIATRY LLC

Practice address

1790 Atkinson Rd Ste D200
Lawrenceville, GA 30043-7991

Phone

(404) 291-6473

NPI assigned

Jul 18, 2016

Last updated

Jul 18, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mi Kim, DPMNPI 1699030163

Title

Owner

Phone

(404) 291-6473

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mi Kyung Kim, DPM

  • Foot & Ankle Surgery Podiatrist
  • Lawrenceville, GA
  • NPI 1699030163
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468800000000",
    "number": "1023461811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 ATKINSON RD STE D200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300437991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 ATKINSON RD STE D200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300437991",
            "telephone_number": "404-291-6473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MK PODIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-18",
        "last_updated": "2016-07-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-291-6473",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Gilbert Mitchell, NP
• Mary Elizabeth Mitchell, PT, DPT
• Naportia Mitchell, PT, DPT, MS
• Stefani Jane Mitchell
• Mjo Enterprises, LLC (BrightStar Care - Lawrenceville GA)
• MK Psychotherapy, Inc.
• MM Surgical Services, LLC
• MMC Home Care, LLC (Home Instead Senior Care)
• Brittany Marie Moates, OD
• Bobak Moazzami, MD

• Foot & Ankle Surgery Podiatrist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Foot & Ankle Surgery Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; 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.