The Widen Clinic

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

THE WIDEN CLINIC

Practice address

3535 Roswell Rd
Ste. 37
Marietta, GA 30062-8826

Phone

(770) 578-1400

NPI assigned

Dec 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Eric Daniel Widen, DPM,DC

Title

Director

Phone

(770) 578-1400

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1073795746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 ROSWELL RD",
            "address_2": "STE. 37",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 ROSWELL RD",
            "address_2": "STE. 37",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628826",
            "telephone_number": "770-578-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WIDEN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "WIDEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "770-578-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM,DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP6040",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.