Provider Demographics
NPI:1376031526
Name:AMIN, TARAK (DPM)
Entity type:Individual
Prefix:DR
First Name:TARAK
Middle Name:
Last Name:AMIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:165 VANN ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7249
Mailing Address - Country:US
Mailing Address - Phone:770-422-9856
Mailing Address - Fax:770-984-0303
Practice Address - Street 1:165 VANN ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7249
Practice Address - Country:US
Practice Address - Phone:770-422-9856
Practice Address - Fax:770-984-0303
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPOD305043213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine