Provider Demographics
NPI:1730360264
Name:AMERICAN FOOT & LEG SPECIALISTS, P.C.
Entity type:Organization
Organization Name:AMERICAN FOOT & LEG SPECIALISTS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OF SURGICAL SERV.
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLASH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-363-9944
Mailing Address - Street 1:425 FOREST PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2185
Mailing Address - Country:US
Mailing Address - Phone:404-363-1087
Mailing Address - Fax:404-363-9951
Practice Address - Street 1:425 FOREST PKWY STE 103
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297
Practice Address - Country:US
Practice Address - Phone:404-363-1087
Practice Address - Fax:404-363-9951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FOOT & LEG SPECIALISTS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-040261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA997391295AMedicaid
GA997391295AMedicaid
GA111024ASCAMedicare PIN