Healthcare Provider Details

I. General information

NPI: 1023789260
Provider Name (Legal Business Name): YONA MIZRAHI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 PARKER RD SE STE B210
CONYERS GA
30094-6670
US

IV. Provider business mailing address

2035 IVAR AVE
LOS ANGELES CA
90068-3918
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-8922
  • Fax:
Mailing address:
  • Phone: 323-509-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD305094
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: