Provider Demographics
NPI:1912429002
Name:DUDEJA, AMISH KUMAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMISH
Middle Name:KUMAR
Last Name:DUDEJA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1975 HIGHWAY 54 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:770-418-0456
Mailing Address - Fax:770-418-1603
Practice Address - Street 1:4385 JOHNS CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6094
Practice Address - Country:US
Practice Address - Phone:770-418-0456
Practice Address - Fax:770-418-1603
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001452213E00000X
GAPOD00001452213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist