MEDICARE: PODIATRY ASSOCIATES OF GEORGIA P C

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
1	261QP1100X	Podiatric Clinic/Center	POD001033	GA

General Provider Information

NPI Number	:	1669626735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY ASSOCIATES OF GEORGIA P C

Provider Business Mailing Address
First Line	:	5200 GREYSTONE SUMMIT DR
Second Line	:	SUITE #1010
City	:	COLUMBUS
State	:	GA
Zip	:	31909-7541
Country	:	US
Telephone Number	:	415-225-5937
Fax Number	:	718-504-6048

Provider Business Practice Location Address
First Line	:	5200 GREYSTONE SUMMIT DR
Second Line	:	SUITE #1010
City	:	COLUMBUS
State	:	GA
Zip	:	31909-7541
Country	:	US
Telephone Number	:	415-225-5937
Fax Number	:	718-504-6048

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. KETAN C DALSANIA
Credential	:	D.P.M.
Telephone Number	:	415-225-5937

Provider Enumeration Date	:	11/15/2008
Last Update Date	:	11/18/2008

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