Organization Name: | CHATEAU FOOT AND ANKLE CENTER, LLC |
NPI Number: | 1134568124 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRADLEY DAVID CASTELLANO (PODIATRIST-OWNER) |
Mailing Address: | 1515 River Pl Suite 140 Braselton |
State: | GA US |
Postal Code: | 305175602 |
Phone Number: | 7706485040 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2013 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | POD000569 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |