Provider Demographics
NPI:1639191646
Name:BANKS, ALAN S (DPM)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:BANKS
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 1:4101 CHARLOTTE AVE STE F185
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4066
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:615-269-3087
Practice Address - Street 1:2295 PARKLAKE DR NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2825
Practice Address - Country:US
Practice Address - Phone:770-938-5974
Practice Address - Fax:770-939-7393
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA545213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
048552OtherBLUE CROSS
480018110OtherMCR RAILROAD
GA000356771DMedicaid
518114OtherAETNA
GAP00370534OtherRAILROAD MEDICARE
GA000356771DMedicaid
GA48SCCWKMedicare PIN
GAU22178Medicare UPIN