Healthcare Provider Details

I. General information

NPI: 1457481558
Provider Name (Legal Business Name): GEORGINA ASANTE D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 10TH AVE SUITE 305
COLUMBUS GA
31901-3600
US

IV. Provider business mailing address

1900 10TH AVE SUITE 305
COLUMBUS GA
31901-3600
US

V. Phone/Fax

Practice location:
  • Phone: 706-576-6844
  • Fax: 706-576-4779
Mailing address:
  • Phone: 706-576-6844
  • Fax: 706-576-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000628
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000628
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number000628
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number000628
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000628
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: