NPIMap

Organization Active NPI

Southwest Atlanta Podiatry, LLC

  • Foot Surgery Podiatrist
  • Atlanta, GA
National Provider Identifier
1124418918
Registry record updated Jan 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
POD 1031 Issued in GA
Legal business name
SOUTHWEST ATLANTA PODIATRY, LLC
Practice address
3915 Cascade Rd SW
Suite 230
Atlanta, GA 30331-8512
Phone
(973) 243-2666
NPI assigned
Jan 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2015

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

Authorized official

Name
Dr. Patricia W Bennett, DPM
Title
Ceo
Phone
(973) 243-2666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0131X POD 1031 GA Primary

Addresses

Primary practice location

3915 Cascade Rd SW
Suite 230
Atlanta, GA 30331-8512

Mailing address

3915 Cascade Rd SW
Atlanta, GA 30331-8512

Other identifiers 1

IdentifierTypeStateIssuer
5551005MedicaidNJ

National Provider Directory

National Provider Directory

Locations

3915 Cascade Rd SW
Ste 230
Atlanta, GA 30331
Phone (404) 963-9511

NPI Registry JSON

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422576000000",
    "number": "1124418918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3915 CASCADE RD SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303318512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 CASCADE RD SW",
            "address_2": "SUITE 230",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303318512",
            "telephone_number": "973-243-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST ATLANTA PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2015-01-30",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "973-243-2666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "GA",
            "license": "POD 1031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5551005",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; 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.