Basic Information
| Provider Information | |||||||||
| NPI: | 1992767594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ULETT | ||||||||
| FirstName: | DANE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 CIRCLE 75 PKWY SE STE 900 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784262171 | ||||||||
| FaxNumber: | 4044461957 | ||||||||
| Practice Location | |||||||||
| Address1: | 2045 PEACHTREE RD NE STE 810 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044461890 | ||||||||
| FaxNumber: | 4044461898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 12/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | POD000960 | GA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 323277 | 01 | GA | UNITED HEALTHCARE | OTHER | 581994261 | 01 | GA | CIGNA | OTHER | 581994261 | 01 | GA | GREAT WEST | OTHER | 000947196K | 05 | GA | MEDICAID | 2847290 | 01 | GA | AETNA | OTHER | 336928 | 05 | GA | MEDICAID | 581994261 | 01 | GA | COVENTRY HEALTHCARE | OTHER | 52887103-033 | 01 | GA | BLUE CROSS BLUE SH OF GA | OTHER | 581994261 | 01 | GA | PHCS | OTHER | 581994261 | 01 | GA | HUMANA | OTHER | 000947196L | 05 | GA | MEDICAID | P00465728 | 01 | GA | RAILROAD MEDICARE | OTHER |