Provider Demographics
NPI:1306153838
Name:MAYEMBE, CLAUDE I SR (DPM)
Entity type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:I
Last Name:MAYEMBE
Suffix:SR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 PEACHTREE PKWY STE D-475
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6054
Mailing Address - Country:US
Mailing Address - Phone:678-288-9205
Mailing Address - Fax:678-926-3550
Practice Address - Street 1:3245 PEACHTREE PKWY STE D-475
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6054
Practice Address - Country:US
Practice Address - Phone:678-288-9205
Practice Address - Fax:678-926-3550
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001203213E00000X
NY006387-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129593Medicaid