NPIMap

Organization Active NPI

Easy Walk Foot Clinic LLC

  • Foot & Ankle Surgery Podiatrist
  • Fayetteville, GA
National Provider Identifier
1508155037
Registry record updated Jul 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
POD001142 Issued in GA
Legal business name
EASY WALK FOOT CLINIC LLC
Practice address
101 Beckett LN
Suite 104
Fayetteville, GA 30214-7155
Phone
(678) 489-6589
Fax
(678) 489-6522
NPI assigned
Apr 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2012

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

Authorized official

Name
Dr. Azuka Ifeyinwa Nwaedozie, D.P.MNPI 1275780199
Title
Podiatrist/Owner
Phone
(678) 489-6589

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 & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X POD001142 GA Primary

Addresses

Primary practice location

101 Beckett LN
Suite 104
Fayetteville, GA 30214-7155

Mailing address

3364 Medina Dr
Jonesboro, GA 30236-6873
Phone (646) 489-6589

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110414000728 GA Part B Supplier - Clinic/Group Practice 1254515265 Receives reassigned benefits from 2 practitioners
Practice locations: Rome, GA

National Provider Directory

National Provider Directory

Locations

101 Beckett Ln
Ste 104
Fayetteville, GA 30214
Phone (678) 489-6589

5604 Wendy Bagwell Pkwy
Ste 311
Hiram, GA 30141
Phone (770) 222-5881

5604 Wendy Bagwell Pkwy
Ste 721
Hiram, GA 30141

253 N Main St
Ste G
Jonesboro, GA 30236
Phone (678) 489-6589

101 John Maddox Dr NW
Ste C
Rome, GA 30165
Phone (678) 489-6589

Practitioners & affiliated clinicians

Practitioners 5

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": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342396800000",
    "number": "1508155037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3364 MEDINA DR",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302366873",
            "telephone_number": "646-489-6589",
            "fax_number": "678-489-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BECKETT LN",
            "address_2": "SUITE 104",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147155",
            "telephone_number": "678-489-6589",
            "fax_number": "678-489-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASY WALK FOOT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2012-07-16",
        "status": "A",
        "authorized_official_last_name": "NWAEDOZIE",
        "authorized_official_first_name": "AZUKA",
        "authorized_official_middle_name": "IFEYINWA",
        "authorized_official_title_or_position": "PODIATRIST/OWNER",
        "authorized_official_telephone_number": "678-489-6589",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.