NPIMap

Organization Active NPI

Modern Podiatry, LLC

  • Podiatric Clinic/Center
  • Griffin, GA
National Provider Identifier
1346070141
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
Legal business name
MODERN PODIATRY, LLC
Practice address
730 S 8TH St
Griffin, GA 30224-4827
Phone
(770) 228-6644
Fax
(770) 228-5769
NPI assigned
Aug 6, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Authorized official

Name
Kibibi Wanzu, DPMNPI 1043689623
Title
Owner
Phone
(470) 781-5585

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Podiatric Clinic/Center 261QP1100X Primary

Addresses

Primary practice location

730 S 8TH St
Griffin, GA 30224-4827

Mailing address

730 S 8TH St
Griffin, GA 30224-4827
Phone (770) 228-6644

National Provider Directory

National Provider Directory
Tax ID family
Modern Podiatry LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1722902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1346070141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 S 8TH ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244827",
            "telephone_number": "770-228-6644",
            "fax_number": "770-228-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 S 8TH ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244827",
            "telephone_number": "770-228-6644",
            "fax_number": "770-228-5769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "WANZU",
        "authorized_official_first_name": "KIBIBI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "470-781-5585",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Griffin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.