Provider Demographics
NPI:1861528689
Name:ALLIED ANKLE & FOOT CARE CENTERS PC
Entity type:Organization
Organization Name:ALLIED ANKLE & FOOT CARE CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-255-0434
Mailing Address - Street 1:PO BOX 491658
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0028
Mailing Address - Country:US
Mailing Address - Phone:770-255-0434
Mailing Address - Fax:770-255-0425
Practice Address - Street 1:15 HURRICANE SHOALS RD NE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4454
Practice Address - Country:US
Practice Address - Phone:770-255-0434
Practice Address - Fax:770-277-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000418213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4017190002Medicare NSC
GAGRP446Medicare ID - Type UnspecifiedMEDICARE GROUP #