Provider Demographics
NPI:1669626735
Name:PODIATRY ASSOCIATES OF GEORGIA P C
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF GEORGIA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
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:415-225-5937
Mailing Address - Street 1:5200 GREYSTONE SUMMIT DR
Mailing Address - Street 2:SUITE #1010
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7541
Mailing Address - Country:US
Mailing Address - Phone:415-225-5937
Mailing Address - Fax:718-504-6048
Practice Address - Street 1:5200 GREYSTONE SUMMIT DR
Practice Address - Street 2:SUITE #1010
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7541
Practice Address - Country:US
Practice Address - Phone:415-225-5937
Practice Address - Fax:718-504-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-15
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001033261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric