Provider Demographics
NPI:1699266759
Name:PINECCA PATEL DPM LLC
Entity type:Organization
Organization Name:PINECCA PATEL DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-844-4329
Mailing Address - Street 1:6 EXECUTIVE PARK DR NE STE 10
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2224
Mailing Address - Country:US
Mailing Address - Phone:404-321-9900
Mailing Address - Fax:404-321-4460
Practice Address - Street 1:6 EXECUTIVE PARK DR NE STE 10
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2224
Practice Address - Country:US
Practice Address - Phone:404-321-9900
Practice Address - Fax:404-321-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001059213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003202355Medicaid