Provider Demographics
NPI:1144408659
Name:ESSENTIAL PODIATRY, LLC
Entity Type:Organization
Organization Name:ESSENTIAL PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAYNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLASH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-827-9362
Mailing Address - Street 1:PO BOX 17881
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-0881
Mailing Address - Country:US
Mailing Address - Phone:404-569-8969
Mailing Address - Fax:404-827-9362
Practice Address - Street 1:285 BOULEVARD
Practice Address - Street 2:SUITE 610
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-222-9914
Practice Address - Fax:404-827-9362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000967213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN