Basic Information
| Provider Information | |||||||||
| NPI: | 1376191106 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RYAN GOLDFINE DPM LLC | ||||||||
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| OtherOrganizationName: | ANKLE AND FOOT CENTERS OF GEORGIA LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1975 HIGHWAY 54 W STE 205 | ||||||||
| Address2: | |||||||||
| City: | PEACHTREE CITY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302694794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785619000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3451 ERNEST W BARRETT PKWY SUITE 170 | ||||||||
| Address2: | |||||||||
| City: | MARIETTTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785619000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2019 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | FRANK | ||||||||
| AuthorizedOfficialFirstName: | RONNETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7707317700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1043662364 | 01 | NPI | OTHER | 1194107425 | 01 | NPI | OTHER |