Basic Information
| Provider Information | |||||||||
| NPI: | 1255764981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHAVIN V. MEHTA, DPM, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1975 HIGHWAY 54 W | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706322043 | ||||||||
| FaxNumber: | 6788541977 | ||||||||
| Practice Location | |||||||||
| Address1: | 5995 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | WARM SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 318302149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066559362 | ||||||||
| FaxNumber: | 7702513462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2013 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | MEHTA | ||||||||
| AuthorizedOfficialFirstName: | BHAVIN | ||||||||
| AuthorizedOfficialMiddleName: | V. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6784162529 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.