Provider Demographics
NPI:1992767594
Name:ULETT, DANE A (DPM)
Entity type:Individual
Prefix:
First Name:DANE
Middle Name:A
Last Name:ULETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:2045 PEACHTREE RD NE STE 810
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1412
Practice Address - Country:US
Practice Address - Phone:404-446-1890
Practice Address - Fax:404-446-1898
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPOD000960213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA323277OtherUNITED HEALTHCARE
GA581994261OtherCIGNA
GA581994261OtherGREAT WEST
GA000947196KMedicaid
GA2847290OtherAETNA
GA336928Medicaid
GA581994261OtherCOVENTRY HEALTHCARE
GA52887103-033OtherBLUE CROSS BLUE SH OF GA
GA581994261OtherPHCS
GA581994261OtherHUMANA
GA000947196LMedicaid
GAP00465728OtherRAILROAD MEDICARE
GA2847290OtherAETNA
GA48SCCTTMedicare PIN
GA1103400022Medicare NSC
GAP00465728Medicare PIN