Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | POD001368 | GA |
N | 2081S0010X | Sports Medicine | POD001368 | GA |
N | 213ES0000X | Sports Medicine | POD001368 | GA |
Y | 213ES0103X | Foot & Ankle Surgery | POD001368 | GA |
NPI | 1275914749 |
---|---|
Provider Name | Nrup Tolat |
First Address | Acworth, GA 30101-8815 |
Second Address | Woodstock, GA 30189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2015 |
Last Update Date | 23/09/2020 |