Provider Demographics
NPI:1801291950
Name:DAGANI, RIZCION BAMBA (DPM)
Entity type:Individual
Prefix:
First Name:RIZCION
Middle Name:BAMBA
Last Name:DAGANI
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:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0003
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:615-269-3087
Practice Address - Street 1:3200 HIGHLANDS PKWY.
Practice Address - Street 2:STE. 100
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5196
Practice Address - Country:US
Practice Address - Phone:770-319-5502
Practice Address - Fax:404-481-4452
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3856213E00000X
GAPOD001366213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist