Georgia Reconstructive Foot and Ankle Center LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

POD001293 Issued in GA

Legal business name

GEORGIA RECONSTRUCTIVE FOOT AND ANKLE CENTER LLC

Practice address

293 N Broad St
Winder, GA 30680-2155

Phone

(770) 867-4110

NPI assigned

Apr 6, 2016

Organization subpart

No

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

Authorized official

Name

Randall Alan Hanson, DPM

Title

Owner

Phone

(678) 770-5838

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Georgia Reconstructive Foot and Ankle Doing business as

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481500800000",
    "number": "1114381027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 N BROAD ST",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306802155",
            "telephone_number": "770-867-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 N BROAD ST",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306802155",
            "telephone_number": "770-867-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA RECONSTRUCTIVE FOOT AND ANKLE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-06",
        "last_updated": "2016-12-12",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-770-5838",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "POD001293",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Reconstructive Foot and Ankle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peter Brian Garner Jr., LMT
• Doy O Gay, M.D.
• Alexis Gaylord, PHARMD
• Georgia CVS Pharmacy LLC
• Georgia Hma Physician Management, LLC
• Georgia Specific Clinic of Chiropractic, Inc.
• Gedion A Getachew, M.D.
• Pamela S Gewirtz, OD
• Taylor Burch Gibson
• Rachelle Lea Gilmore, FNP

• Foot & Ankle Surgery Podiatrist in Winder, GA
• Providers in Winder, 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 Dec 12, 2016; 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.