Provider Demographics
NPI:1255764981
Name:BHAVIN V. MEHTA, DPM, LLC
Entity type:Organization
Organization Name:BHAVIN V. MEHTA, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:678-416-2529
Mailing Address - Street 1:1975 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4794
Mailing Address - Country:US
Mailing Address - Phone:770-632-2043
Mailing Address - Fax:678-854-1977
Practice Address - Street 1:5995 SPRING ST
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-2149
Practice Address - Country:US
Practice Address - Phone:706-655-9362
Practice Address - Fax:770-251-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty