Basic Information
| Provider Information | |||||||||
| NPI: | 1528178530 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VILLAGE PODIATRY GROUP, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 VILLAGE GREEN CIR SE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300803476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703840284 | ||||||||
| FaxNumber: | 7708742496 | ||||||||
| Practice Location | |||||||||
| Address1: | 2850 HOG MOUNTAIN RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | DACULA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300191012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044461940 | ||||||||
| FaxNumber: | 4044461941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HELFMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | N. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7703840284 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.P.M. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | GRP2066 | 01 | GA | MEDICARE GROUP NUMBER | OTHER |