=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639191646
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN S BANKS DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 05/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2295 PARKLAKE DR NE SUITE 150
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30345-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-938-5974
-----------------------------------------------------
Fax | 770-939-7393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4101 CHARLOTTE AVE STE F185
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37209-4066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-426-2171
-----------------------------------------------------
Fax | 615-269-3087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 545
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------