DR. PRAYA MAM (NPI# 1710964408) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710964408 |
| Entity Type | Individual |
| Full Name | DR. PRAYA MAM |
| Credential | D.P.M. |
| Practice Address |
4877 Bill Gardner Pkwy Locust Grove GA 30248 |
| Mailing Address |
425 Forest Pkwy Suite 101 Forest Park GA 30297-2185 |
| Practice Telephone | 4043639944 |
| Practice Fax Number | 6784327040 |
| Mailing Telephone | 4043639944 |
| Mailing Fax Number | 4043639951 |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2018-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
00723 | GA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00614105A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1109 Eagles Landing Pkwy, Stockbridge, GA 302816394 | 4043639944 | 7705078706 |
| 425 Forest Pkwy, Suite 101, Forest Park, GA 302972185 | 4043639944 | 4043639951 |
| 425 Forest Pkwy Ste 101, Forest Park, GA 302972135 |
| Street Address |
4877 BILL GARDNER PKWY |
| City | LOCUST GROVE |
| State | GA |
| Zip Code | 30248 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225324635 | Monica Mone' Smith | Physical Therapist | 4877 Bill Gardner Pkwy, Locust Grove, GA 30248-3644 | 2011-06-23 |
| 1750687737 | American Foot & Leg Specialists, P.C. | Podiatrist | 4877 Bill Gardner Pkwy, Locust Grove, GA 30248 | 2011-02-08 |
| 1114002037 | Physiotherapy Associates Inc | Clinic/Center | 4877 Bill Gardner Pkwy, Locust Grove, GA 30248-3644 | 2006-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346809779 | Uyen Nguyen | Dentist | 4146 Ga-42, Locust Grove, GA 30248 | 2019-06-10 |
| 1669038303 | Monique Antoinette Joseph | Nurse Practitioner | 3334 Highway 155 Ste B, Locust Grove, GA 30248 | 2019-05-17 |
| 1811552524 | Fresenius Medical Care Locust Grove, LLC | Clinic/Center | 2855 Ga-155 S, Locust Grove, GA 30248 | 2019-05-08 |
| 1972167765 | Wesley Todd Livingston | Pharmacist | 2730 Ga 155, Locust Grove, GA 30248 | 2019-04-26 |
| 1053974550 | Wish You Well Youth Faith Foundation Inc | Contractor | 147 Laughlin Dr, Locust Grove, GA 30248 | 2019-04-19 |
| 1740776517 | Takle Eye Surgery Center LLC | Clinic/Center | 1075 Bandy Pkwy, Ste 105, Locust Grove, GA 30248 | 2018-07-05 |
| 1508357559 | Justin Robert Crumpton | Behavioral Analyst | 212 Westin Park Dr, Locust Grove, GA 30248 | 2018-05-25 |
| 1730679051 | Lisa Renee Jones | Family Medicine | 3778 G 42, Locus Grove, GA 30248 | 2018-05-11 |
| 1275042152 | Stephanie Jones Headen | Counselor | 211 Peeksville Rd., Locust Grove, GA 30248 | 2017-09-23 |
| 1942735592 | Brandi Nicole Buice Minter | Pharmacist | 4920 Bill Gardner Parkway, Locust Grove, GA 30248 | 2017-04-20 |
| Find all providers in zip 30248 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750687737 | American Foot & Leg Specialists, P.C. | Podiatrist | 4877 Bill Gardner Pkwy, Locust Grove, GA 30248 | 2011-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518515980 | Da Vinci Foot and Ankle Madison LLC | Podiatrist | 1740 Lions Club Rd Ste 200, Madison, GA 30650-4762 | 2019-08-29 |
| 1376191106 | Ryan Goldfine Dpm LLC | Podiatrist | 3451 Ernest W Barrett Pkwy Suite 170, Mariettta, GA 30269 | 2019-08-26 |
| 1073076170 | Kalish Foot & Ankle Institute | Podiatrist | 6911 Tara Blvd Ste 101, Jonesboro, GA 30236-1503 | 2019-04-08 |
| 1427523919 | Tommy Lee Tally | Podiatrist | 8225 Mall Pkwy Ste 230, Lithonia, GA 30038-6913 | 2018-10-10 |
| 1881188944 | Joshua Jae Lee | Podiatrist | 3425 Buford Dr Ste 350, Buford, GA 30519-8785 | 2018-06-21 |
| 1437652815 | Southeast Regional Primary Care Corporation | Podiatrist | 1707 Meadows Ln Ste H, Vidalia, GA 30474-7201 | 2018-03-13 |
| 1447762927 | Ponders Podiatry LLC | Podiatrist | 275 Carpenter Drive Ne, Suite 106, Atlanta, GA 30328 | 2017-10-24 |
| 1194245894 | Yusuf Abiodun Opakunle | Podiatrist | 600 Professional Dr Ste 130, Lawrenceville, GA 30046-7638 | 2017-06-23 |
| 1891228540 | Vishal Patel | Podiatrist | 755 Mount Vernon Hwy Ne Ste 210, Atlanta, GA 30328-4279 | 2017-04-10 |
| 1497296552 | Ankle and Foot Assoc, LLC | Podiatrist | 118 Azalea Rd, Suite 1-2, Baxley, GA 31513-0672 | 2017-03-09 |
| Find all providers with the same taxonomy | ||||
| City | LOCUST GROVE |
| Zip Code | 30248 |
Please comment or provide details below to improve the information on DR. PRAYA MAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.