Provider Demographics
NPI:1598269714
Name:DWAYNE A LAY LLC
Entity Type:Organization
Organization Name:DWAYNE A LAY LLC
Other - Org Name:ELITE FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-765-5828
Mailing Address - Street 1:10515 BELLS FERRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4242
Mailing Address - Country:US
Mailing Address - Phone:770-765-5828
Mailing Address - Fax:678-388-0977
Practice Address - Street 1:10515 BELLS FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4242
Practice Address - Country:US
Practice Address - Phone:770-765-5828
Practice Address - Fax:678-388-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001230213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1598269714OtherAETNA
GA1598269714OtherTRANS AMERICA
GA1598269714OtherUNITED OF OMAHA
GA1598269714OtherANTHEM OF GEORGIA
GA1598269714OtherCHAMPVA
GA1598269714OtherGHI
GA1598269714OtherUNITEDHEALTHCARE
GA1598269714OtherCIGNA
GA1598269714OtherTRICARE EAST/LIFE/PRIME
GA1598269714OtherRAILROAD MEDICARE
GA1598269714OtherHUMANA
GA1598269714OtherTRANS AMERICA
GA1598269714OtherPEACH STATE GEORGIA
GA1598269714OtherGHI
GA1598269714OtherWELLCARE OF GEORGIA
GA1598269714OtherAETNA