S.Dekalb Foot & Ankle Surgical Ctr

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

000753 Issued in GA

Legal business name

S.DEKALB FOOT & ANKLE SURGICAL CTR

Practice address

841 Mulberry St
Macon, GA 31201-6756

Phone

(478) 741-1192

Fax

(478) 741-0029

NPI assigned

Jun 25, 2007

Organization subpart

No

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

Authorized official

Name

Roger Peter Theodore, DPM

Title

Podiatrist

Phone

(404) 241-7848

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• FAMILY FOOT & ANKLE CTR Doing business as

Locations

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265638381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2889 S RAINBOW DR",
            "address_2": "SUITE C",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341670",
            "telephone_number": "404-241-7848",
            "fax_number": "404-241-2161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 MULBERRY ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016756",
            "telephone_number": "478-741-1192",
            "fax_number": "478-741-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S.DEKALB FOOT & ANKLE SURGICAL CTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THEODORE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "404-241-7848",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "GA",
            "license": "000753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00655322A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY FOOT & ANKLE CTR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rutland Medical Supply
• Katie Elizabeth Rutland, MA
• Deborah K Ryan, R.P.T.
• Samantha Nicole Ryan, BCBA
• S. Jackson Psychiatry
• S.E. Family Foot & Ankle Center LLC
• Lino Daniel Saavedra, MD
• Maher Sabalbal, MD
• Carson Anne Sabir
• Alexander Sabol, MD

• All providers in Macon, GA
• Podiatric Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.