| Southeast Podiatry | |
|
3225 Shallowford Rd Suite 200 Marietta GA 30062-1266 | |
| (770) 675-7904 | |
| (770) 675-7906 |
| Full Name | Southeast Podiatry |
|---|---|
| Speciality | Clinic/Center |
| Location | 3225 Shallowford Rd, Marietta, Georgia |
| Authorized Official Name and Position | Suzanne Marie Clous (PODIATRIST) |
| Authorized Official Contact | 7708527035 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Podiatry 3225 Shallowford Rd Suite 200 Marietta GA 30062-1266 Ph: (770) 675-7904 | Southeast Podiatry 3225 Shallowford Rd Suite 200 Marietta GA 30062-1266 Ph: (770) 675-7904 |
| NPI Number | 1154568582 |
|---|---|
| Provider Enumeration Date | 01/07/2009 |
| Last Update Date | 11/19/2014 |
| Medicare PECOS PAC ID | 5496805673 |
|---|---|
| Medicare Enrollment ID | O20090609000646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154568582 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | POD001011 (Georgia) | Primary |
| 335E00000X | Prosthetic/orthotic Supplier | POD001011 (Georgia) | Secondary |
| Provider Name | Suzanne M Clous |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1225012156 PECOS PAC ID: 8628019254 Enrollment ID: I20050513000403 |
| Provider Name | Marie-christine Bergeron |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1447653761 PECOS PAC ID: 6103125778 Enrollment ID: I20160503001399 |
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