MEDICARE: DR. PRAYA MAM D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	00723	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710964408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAYA MAM D.P.M.

Provider Business Mailing Address
First Line	:	425 FOREST PKWY
Second Line	:	SUITE 101
City	:	FOREST PARK
State	:	GA
Zip	:	30297-2185
Country	:	US
Telephone Number	:	404-363-9944
Fax Number	:	404-363-9951

Provider Business Practice Location Address
First Line	:	4877 BILL GARDNER PKWY
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248
Country	:	US
Telephone Number	:	404-363-9944
Fax Number	:	678-432-7040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/23/2018

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Directions to “ DR. PRAYA MAM D.P.M.” Practice Location

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