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General NPI Number Information
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NPI Number | 1699724427
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Entity Type | Individual
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Provider Name | MAITRAYA D THAKER DPM
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Gender | Male
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 4385 JOHNS CREEK PKWY STE 200
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City | SUWANEE
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State | GA
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Zip | 30024-6094
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Country | US
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Telephone | 770-349-9861
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Fax |
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Provider Business Mailing Address
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Address Line | 1975 HIGHWAY 54 W STE 205
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4794
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Country | US
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Telephone | 678-561-9000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | N004044-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000650
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License Number State | GA
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