Provider Demographics
NPI:1871929893
Name:PODIATRY CARE OF GEORGIA
Entity type:Organization
Organization Name:PODIATRY CARE OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-904-3773
Mailing Address - Street 1:415 ARMOUR DR NE
Mailing Address - Street 2:3103
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3933
Mailing Address - Country:US
Mailing Address - Phone:404-904-3773
Mailing Address - Fax:
Practice Address - Street 1:415 ARMOUR DR NE
Practice Address - Street 2:3103
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3933
Practice Address - Country:US
Practice Address - Phone:404-904-3773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000931213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty