Provider Demographics
NPI:1902997026
Name:BYRON, DEBBIE L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:L
Last Name:BYRON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 VETERANS MEMORIAL HWY SE
Mailing Address - Street 2:SUITE 134 #139
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2945
Mailing Address - Country:US
Mailing Address - Phone:678-662-9406
Mailing Address - Fax:770-944-9061
Practice Address - Street 1:252 TONY TRL SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3655
Practice Address - Country:US
Practice Address - Phone:678-662-9406
Practice Address - Fax:770-944-9061
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000721213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00630374DMedicaid
GA000630374FMedicaid
GA000630374FMedicaid
GAU49736Medicare UPIN