Provider Demographics
NPI:1902077019
Name:DR.M.NIKNAFS PODIATRIST PC
Entity Type:Organization
Organization Name:DR.M.NIKNAFS PODIATRIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKNAFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-548-2544
Mailing Address - Street 1:1010 PRINCE AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5815
Mailing Address - Country:US
Mailing Address - Phone:706-548-2544
Mailing Address - Fax:
Practice Address - Street 1:1010 PRINCE AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5805
Practice Address - Country:US
Practice Address - Phone:706-548-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00299637BMedicaid
GAT51184Medicare UPIN
GA00299637BMedicaid
GA4201900002Medicare NSC