Provider Demographics
NPI:1306867254
Name:ATLANTA PODIATRY PC
Entity Type:Organization
Organization Name:ATLANTA PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPAL
Authorized Official - Middle Name:PATEL
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-418-0456
Mailing Address - Street 1:4385 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6093
Mailing Address - Country:US
Mailing Address - Phone:770-418-0456
Mailing Address - Fax:
Practice Address - Street 1:4385 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6093
Practice Address - Country:US
Practice Address - Phone:770-418-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000958213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU94009Medicare UPIN
GA5363600001Medicare NSC
GAGRP6991Medicare PIN
GAU80353Medicare UPIN