Provider Demographics
NPI:1174026454
Name:EAST ALABAMA PODIATRY, PC
Entity Type:Organization
Organization Name:EAST ALABAMA PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KETAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DALSANIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-538-7019
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-0597
Mailing Address - Country:US
Mailing Address - Phone:336-306-9755
Mailing Address - Fax:
Practice Address - Street 1:3320 SKYWAY DR STE 802
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7141
Practice Address - Country:US
Practice Address - Phone:404-538-7019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBL001588012018261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric