Provider Demographics
NPI:1447235627
Name:VASENDEN, NELS ARVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:NELS
Middle Name:ARVID
Last Name:VASENDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2445
Mailing Address - Country:US
Mailing Address - Phone:706-546-7417
Mailing Address - Fax:706-546-0794
Practice Address - Street 1:298 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2445
Practice Address - Country:US
Practice Address - Phone:706-546-7417
Practice Address - Fax:706-546-0794
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000312213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00006278AMedicaid
U05540Medicare UPIN