NPIMap

Organization Active NPI

Flat Shoals Foot & Ankle Center, LLC

  • Foot Surgery Podiatrist
  • Decatur, GA
National Provider Identifier
1154500320
Registry record updated Oct 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
POD000952 Issued in GA
Legal business name
FLAT SHOALS FOOT & ANKLE CENTER, LLC
Practice address
2855 Candler Rd
Suite 10
Decatur, GA 30034-1415
Phone
(404) 241-7400
Fax
(404) 241-7475
NPI assigned
Oct 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2012

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

Authorized official

Name
Dr. Suzette Andrean Clements, DPMNPI 1003846718
Title
Owner
Phone
(404) 241-7400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0131X POD000952 GA Primary

Addresses

Primary practice location

2855 Candler Rd
Suite 10
Decatur, GA 30034-1415

Mailing address

2855 Candler Rd
Suite 10
Decatur, GA 30034-1415
Phone (404) 241-7400

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040423000649 GA Part B Supplier - Clinic/Group Practice 6406842434 Receives reassigned benefits from 1 practitioner
Practice locations: Decatur, GA
O20110325000400 GA DME Supplier - Physician - Podiatry 6406842434 Practice locations: Decatur, GA

National Provider Directory

National Provider Directory
Tax ID family
Flat Shoals Foot and Ankle Center2 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

5040 Snapfinger Woods Dr
Ste 206
Decatur, GA 30035
Phone (404) 975-4684

4535 Flat Shoals Pkwy
Ste 301
Decatur, GA 30034
Phone (404) 244-9477

2855 Candler Rd
Ste 10
Decatur, GA 30034
Phone (404) 241-7400

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349222400000",
    "number": "1154500320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 CANDLER RD",
            "address_2": "SUITE 10",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341415",
            "telephone_number": "404-241-7400",
            "fax_number": "404-241-7475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 CANDLER RD",
            "address_2": "SUITE 10",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341415",
            "telephone_number": "404-241-7400",
            "fax_number": "404-241-7475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLAT SHOALS FOOT & ANKLE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2012-10-03",
        "status": "A",
        "authorized_official_last_name": "CLEMENTS",
        "authorized_official_first_name": "SUZETTE",
        "authorized_official_middle_name": "ANDREAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-241-7400",
        "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": "POD000952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; 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.