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NPI Code Detail

MEDICARE: DR. TATYANA DERVIL DPM

MEDICARE: DR. TATYANA DERVIL DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist4757FL

General Provider Information

NPI Number : 1396525861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TATYANA DERVIL DPM
Provider Business Mailing Address
First Line : 3086 JONESBORO ST
Second Line :
City : ELLENWOOD
State : GA
Zip : 30294-3619
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1670 CLAIRMONT RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-4004
Country : US
Telephone Number : 404-695-2611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2023
Last Update Date : 03/25/2026

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Directions to “ DR. TATYANA DERVIL DPM” Practice Location

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