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1053801498 NPI number — JOSEPH NICHOLAS COLASURDO DPM

NPI Number: 1053801498
Health Care Provider/Practitioner: JOSEPH NICHOLAS COLASURDO DPM

Information about “1053801498” NPI (JOSEPH NICHOLAS COLASURDO DPM) exists in 1053801498 in HTML format HTML  |  1053801498 in plain Text format TXT  |  1053801498 in PDF (Portable Document Format) PDF  |  1053801498 in an XML format XML  formats.

NPI Number : 1053801498 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053801498",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLASURDO",
    "FirstName": "JOSEPH",
    "MiddleName": "NICHOLAS",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DPM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6350 LAKE OCONEE PKWY STE 110",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENSBORO",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30642-6490",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-597-0102",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1610 MARS HILL RD STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATKINSVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30677-4891",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "762-999-8090",
    "PracticeLocationAddressFaxNumber": "706-597-1998",
    "EnumerationDate": "05/11/2018",
    "LastUpdateDate": "04/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "213E00000X",
          "TaxonomyName": "Podiatrist",
          "LicenseNumber": "POD001547",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213ES0103X",
          "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
          "LicenseNumber": "007215",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213ES0103X",
          "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
          "LicenseNumber": "POD001547",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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