Provider Demographics
NPI:1356549141
Name:LAY, DWAYNE (DPM)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:
Last Name:LAY
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 1:10515 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
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001230213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA824638527OtherBCBSGA, UNITED HEALTHCARE, AETNA, HUMANA, CIGNA
GA824638527Medicaid