Provider Demographics
NPI:1235747031
Name:LAWRENCEVILLE FOOT AND ANKLE SPECIALISTS
Entity type:Organization
Organization Name:LAWRENCEVILLE FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YUSUF
Authorized Official - Middle Name:
Authorized Official - Last Name:OPAKUNLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-757-7516
Mailing Address - Street 1:600 PROFESSIONAL DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7638
Mailing Address - Country:US
Mailing Address - Phone:651-757-7516
Mailing Address - Fax:
Practice Address - Street 1:600 PROFESSIONAL DR STE 130
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7638
Practice Address - Country:US
Practice Address - Phone:770-225-0434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty