South Fulton Family Foot Care, Inc.

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

697 Issued in GA

Legal business name

SOUTH FULTON FAMILY FOOT CARE, INC.

Practice address

67 W Campbellton St
Fairburn, GA 30213-1338

Phone

(770) 964-2201

Fax

(770) 306-9744

NPI assigned

May 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Rona Renell Green, DPMNPI 1659467223

Title

Ceo

Phone

(770) 964-2201

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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

• Rona Renell Green, DPM

  • Foot & Ankle Surgery Podiatrist
  • Fairburn, GA
  • NPI 1659467223
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1179014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1154536126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302130188",
            "telephone_number": "770-964-2201",
            "fax_number": "770-306-9744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 W CAMPBELLTON ST",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302131338",
            "telephone_number": "770-964-2201",
            "fax_number": "770-306-9744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH FULTON FAMILY FOOT CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-13",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "RONA",
        "authorized_official_middle_name": "RENELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-964-2201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "GA",
            "license": "697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA AETNA PPO NUMBER",
            "identifier": "4355747",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA BCBS NUMBER",
            "identifier": "451998",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA STATE LICENSE NUMBER",
            "identifier": "697",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatric Clinic/Center in Fairburn, GA
• Providers in Fairburn, GA by specialty
• Podiatric Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.