Provider Demographics
NPI:1699724427
Name:THAKER, MAITRAYA D (DPM)
Entity type:Individual
Prefix:DR
First Name:MAITRAYA
Middle Name:D
Last Name:THAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:D
Other - Last Name:THAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1975 HIGHWAY 54 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:
Practice Address - Street 1:4385 JOHNS CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6094
Practice Address - Country:US
Practice Address - Phone:770-349-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004044-1213ES0103X
GA000650213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty