Organization Active NPI

Choice Podiatry Center, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Marietta, GA
National Provider Identifier
1053583666
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
POD001071 Issued in GA
Legal business name
CHOICE PODIATRY CENTER, INC.
Practice address
540 Powder Springs St Ste B6
Marietta, GA 30064-3559
Phone
(770) 702-8723
Fax
(707) 702-8809
NPI assigned
Mar 24, 2008
Last updated
Jan 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

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

Authorized official

Name
Latisha Cheree McLean
Title
Office Manger
Phone
(770) 702-8723

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X POD001071 GA Primary

Addresses

Primary practice location

540 Powder Springs St Ste B6
Marietta, GA 30064-3559

Mailing address

540 Powder Springs St Ste B6
Marietta, GA 30064-3559
Phone (770) 702-8723

Other practice location 1

540 Powder Springs St Ste B6
Marietta, GA 30064-3559
Phone (770) 702-8723

Other identifiers 1

IdentifierTypeStateIssuer
P00460780OtherGARAILROAD MEDICARE

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100208000386 GA Part B Supplier - Clinic/Group Practice 8022151422 Receives reassigned benefits from 1 practitioner
Practice locations: Marietta, GA
O20100930004749 GA DME Supplier - Physician - Podiatry 8022151422 Practice locations: Marietta, GA

National Provider Directory

National Provider Directory
Tax ID family
Choice Podiatry Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2450 Atlanta Hwy
Ste 402
Cumming, GA 30040
Phone (678) 807-8320

540 Powder Springs St
Ste B6
Marietta, GA 30064
Phone (678) 807-8320

4500 West Village Pl SE
Unit 2003
Smyrna, GA 30080
Phone (770) 702-8723

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1053583666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 POWDER SPRINGS ST STE B6",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300643559",
            "telephone_number": "770-702-8723",
            "fax_number": "770-702-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 POWDER SPRINGS ST STE B6",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300643559",
            "telephone_number": "770-702-8723",
            "fax_number": "707-702-8809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "540 Powder Springs St Ste B6",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300643559",
            "country_code": "US",
            "telephone_number": "770-702-8723",
            "fax_number": "770-702-8809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHOICE PODIATRY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2021-01-19",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "MCLEAN",
        "authorized_official_first_name": "LATISHA",
        "authorized_official_middle_name": "CHEREE",
        "authorized_official_title_or_position": "OFFICE MANGER",
        "authorized_official_telephone_number": "770-702-8723"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00460780",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; 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.