Organization
NORTH FULTON PODIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEAN P KOSTAKOS DPM (OWNER)
(770) 346-7500
Entity
Organization
Contact information
Practice address
1380 UPPER HEMBREE RD, ROSWELL, GA 30076-1146
(770) 346-7500
(770) 346-8800
Mailing address
1380 UPPER HEMBREE RD, ROSWELL, GA 30076-1146
(770) 346-7500
(770) 346-8800
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00605
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5271380001
DMERC
GA
01
—
DC3957
RAILROAD MEDICARE
GA
Enumeration date
12/04/2007
Last updated
12/21/2007
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