Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | POD001230 | GA |
Y | 213ES0103X | Foot & Ankle Surgery | POD001230 | GA |
NPI | 1356549141 |
---|---|
Provider Name | Dr. Dwayne Lay |
First Address | Canton, GA 30114-4242 |
Second Address | Canton, GA 30114-4242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 13/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
824638527 | BCBSGA, UNITED HEALTHCARE, AETNA, HUMANA, CIGNA (01) | GA |