Provider Demographics
NPI:1164405551
Name:DY, ANGELINE D (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANGELINE
Middle Name:D
Last Name:DY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1029 N PEACHTREE PKWY # 209
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4210
Mailing Address - Country:US
Mailing Address - Phone:850-420-3703
Mailing Address - Fax:855-721-5989
Practice Address - Street 1:9104 MIDDLEGROUND RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4320
Practice Address - Country:US
Practice Address - Phone:912-927-8011
Practice Address - Fax:912-927-8311
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2162213E00000X
AL218213E00000X
PASC004039-L213E00000X
GAPOD000806213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA169015904Medicaid
PA169015904Medicaid
PA651856Medicare PIN