LOWER EXTREMITY DIAGNOSTICS, LLC (NPI# 1770991861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770991861 |
| Entity Type | Organization |
| Organization Name | LOWER EXTREMITY DIAGNOSTICS, LLC |
| Practice Address |
6911 Tara Boulevard Jonesboro GA 30236 |
| Practice Telephone | 7704779535 |
| Mailing Telephone | 7704779535 |
| Mailing Fax Number | 7704717826 |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2014-08-01 |
| Authorized Official Name | DR. STANLEY KALISH (MEMBER) |
| Authorized Official Telephone | 7704779535 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ER0200X |
Podiatrist Specialization: Radiology |
POD000382 | GA | Podiatric Medicine & Surgery Service Providers |
| Street Address |
6911 TARA BOULEVARD |
| City | JONESBORO |
| State | GA |
| Zip Code | 30236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972123362 | Life Source Counseling & Consulting, LLC | Clinic/Center | 118 North Avenue, Suite A, Jonesboro, GA 30236 | 2020-04-25 |
| 1639609555 | New Beginnings Behavioral Counseling,llc | Social Worker | 9456 S Main St Ste E2, Jonesboro, GA 30236 | 2017-06-13 |
| 1437696762 | Clarissa Alexandra Poole | Counselor | 2106 Fair Ridge Ct, Jonesboro, GA 30236 | 2017-01-25 |
| 1588012892 | Sundance Healthcare Service Inc | In Home Supportive Care | 7861 Collinswood Court, Jonesboro, GA 30236 | 2016-05-26 |
| 1942669205 | Adrianne Smiley Gurley | Occupational Therapist | 1299 Battlecreek Rd Ste 210, Jonesboro, GA 30236 | 2016-02-15 |
| 1336505809 | Integrated Health Center | Dentist | 8600 Tara Blvd, Suite D, Jonesboro, GA 30236 | 2016-01-13 |
| 1467827402 | Surrell Porter | Nurse Practitioner | 1287 Georgia Highway 138 Spur, Suite 8, Jonesboro, GA 30236 | 2015-12-02 |
| 1740688910 | Jacqueline Carolyn Edwards | Registered Nurse | 8081 Tara Blvd, 265, Jonesboro, GA 30236 | 2014-12-19 |
| 1760899710 | Fresenius Medical Care Jonesboro, LLC | Clinic/Center | 8060 Summitt Business Parkway, Jonesboro, GA 30236 | 2014-07-22 |
| 1184045163 | Diane Johnson | Community/Behavioral Health | 1141 Gable Terrace, Jonesboro, GA 30236 | 2013-12-18 |
| Find all providers in zip 30236 | ||||
| Taxonomy Code | 213ER0200X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508284175 | Interventional Institute of Georgia | Podiatrist | 7130 Mount Zion Blvd, Suite 2, Jonesboro, GA 30236-2566 | 2014-04-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083696090 | Matthew C D Eller | Podiatrist | 2500 Starling St, Suite 301, Brunswick, GA 31520-4265 | 2005-11-16 |
| 1083696389 | Brett A Bodamer | Podiatrist | 2500 Starling St, Suite 301, Brunswick, GA 31520-4265 | 2005-11-14 |
Please comment or provide details below to improve the information on LOWER EXTREMITY DIAGNOSTICS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.