Modern Podiatry, LLC

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

Legal business name

MODERN PODIATRY, LLC

Practice address

1825 Highway 34 E Ste 3410
Newnan, GA 30265-6433

Phone

(770) 251-8940

Fax

(770) 251-5685

NPI assigned

Aug 6, 2024

Last updated

Aug 6, 2024By the provider in NPPES

Organization subpart

No

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

Specialties & licenses 1

Addresses

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.

• Modern Podiatry, LLC

  • Podiatric Clinic/Center
  • Griffin, GA
  • NPI 1346070141
  NPD tax ID
• Modern Podiatry, LLC

  • Podiatric Clinic/Center
  • McDonough, GA
  • NPI 1811538390
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kibibi Wanzu

  • Foot & Ankle Surgery Podiatrist
  • McDonough, GA
  • NPI 1043689623
  NPD (past) Authorized official

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": "1871323683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 HIGHWAY 34 E STE 3410",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302656433",
            "telephone_number": "770-251-8940",
            "fax_number": "770-251-5685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 HIGHWAY 34 E STE 3410",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302656433",
            "telephone_number": "770-251-8940",
            "fax_number": "770-251-5685"
        }
    ],
    "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": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shantorius Mitchell
• Cheyenne Rachelle Mix I
• Destin Mizelle
• Mjyj Inc
• Mobility Express of Georgia, Inc (Mobility Express)
• Andrew Thomas Modi, PT, DPT
• Heide H. Moeling, M.D.
• Michelle Diana Mon, MD
• Christina M Mondy, CRNA
• Brianna Monk

• Podiatric Clinic/Center in Newnan, GA
• Providers in Newnan, 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 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.