Provider Demographics
NPI:1679739742
Name:ESCALEA, CANDICE NICOLE (DPM)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:NICOLE
Last Name:ESCALEA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 POWDER SPRINGS RD SW STE C
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4573
Mailing Address - Country:US
Mailing Address - Phone:678-370-0970
Mailing Address - Fax:
Practice Address - Street 1:2483 POWDER SPRINGS RD SW STE C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4573
Practice Address - Country:US
Practice Address - Phone:678-370-0970
Practice Address - Fax:678-370-0971
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001116213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA067626489AMedicaid
GA067626489AMedicaid
GA202I489723Medicare PIN