Healthcare Provider Details

I. General information

NPI: 1730824905
Provider Name (Legal Business Name): NEIL SATISH UPADHYAY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 JOE FRANK HARRIS PKWY SE BLDG A106
CARTERSVILLE GA
30120-2151
US

IV. Provider business mailing address

1975 HIGHWAY 54 W STE 205
PEACHTREE CITY GA
30269-4794
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-1389
  • Fax: 770-386-4894
Mailing address:
  • Phone: 678-902-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001556
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: