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General NPI Number Information
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NPI Number | 1598269714
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Entity Type | Organization
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Legal Business Name | DWAYNE A LAY LLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 10515 BELLS FERRY RD STE 200
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City | CANTON
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State | GA
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Zip | 30114-4242
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Country | US
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Telephone | 770-765-5828
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Fax | 678-388-0977
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Provider Business Mailing Address
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Address Line | 10515 BELLS FERRY RD STE 200
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City | CANTON
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State | GA
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Zip | 30114-4242
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Country | US
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Telephone | 770-765-5828
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Fax | 678-388-0977
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DWAYNE A LAY
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Credential | DPM
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Telephone | 770-765-5828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001230
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License Number State | GA
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