Active NPI
Marietta Podiatry Group
- Durable Medical Equipment & Medical Supplies
- Marietta, GA
National Provider Identifier
1306960836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- MARIETTA PODIATRY GROUP
- Practice address
- 165 Vann St NE
Marietta, GA 30060-7249 - Phone
- (770) 422-9856
- Fax
- (770) 984-0303
- NPI assigned
- Mar 19, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Glyn E. Lewis, DPM
- Title
- Ceo
- Phone
- (770) 422-9856
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | GA | Primary | |
| Customized Equipment (DME) | 332BC3200X | GA |
Addresses
Primary practice location
165 Vann St NE
Marietta, GA 30060-7249
Mailing address
165 Vann St NE
Marietta, GA 30060-7249
Phone (770) 422-9856
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040419001215 | GA | Part B Supplier - Clinic/Group Practice | 5092700922 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marietta, GA |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Marietta Podiatry Group
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Podiatric Clinic/Center
- Marietta, GA
- NPI 1487638318
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Foot & Ankle Surgery Podiatrist
- Marietta, GA
- NPI 1376031526
-
- Foot & Ankle Surgery Podiatrist
- Marietta, GA
- NPI 1124002050
-
- Foot & Ankle Surgery Podiatrist
- Canton, GA
- NPI 1154941714
-
- Physical Therapist
- Marietta, GA
- NPI 1790731982
-
- Foot & Ankle Surgery Podiatrist
- Marietta, GA
- NPI 1417342700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1325721600000",
"number": "1306960836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 VANN ST NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300607249",
"telephone_number": "770-422-9856",
"fax_number": "770-984-0303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 VANN ST NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300607249",
"telephone_number": "770-422-9856",
"fax_number": "770-984-0303"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARIETTA PODIATRY GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-19",
"last_updated": "2012-01-05",
"status": "A",
"authorized_official_last_name": "LEWIS",
"authorized_official_first_name": "GLYN",
"authorized_official_middle_name": "E.",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "770-422-9856",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "GA",
"license": null,
"primary": true
},
{
"code": "332BC3200X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
"state": "GA",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
- Marietta Outpatient Surgery, LTD
- Marietta Pastoral Counseling Center, Inc.
- Marietta Physical Rehab, L.L.C.
- Marietta Plastic Surgery
- Marietta Plastic Surgery
- Marietta Podiatry Group
- Marietta Psychiatry Associates PC
- Marietta Public Health Center (Cobb County Board of Health)
- Marietta Rheumatology Associates, P.C.
- Marietta Roswell Counseling, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.