NPIMap

Organization Active NPI

Divine Podiatry

  • Podiatrist
  • Dacula, GA
National Provider Identifier
1104235613
Registry record updated Apr 18, 2020
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Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
POD00148 Issued in GA
Legal business name
DIVINE PODIATRY
Practice address
1204 Bentley Estates Dr
Dacula, GA 30019-7786
Phone
(609) 922-1866
NPI assigned
Aug 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Aliya Matthews, DPM
Title
Podiatrist
Phone
(609) 922-1866

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X POD00148 GA Primary

Addresses

Primary practice location

1204 Bentley Estates Dr
Dacula, GA 30019-7786

Mailing address

1204 Bentley Estates Dr
Dacula, GA 30019-7786
Phone (609) 922-1866

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587168000000",
    "number": "1104235613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 BENTLEY ESTATES DR",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300197786",
            "telephone_number": "609-922-1866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 BENTLEY ESTATES DR",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300197786",
            "telephone_number": "609-922-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PODIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-08",
        "last_updated": "2020-04-18",
        "certification_date": "2020-04-18",
        "status": "A",
        "authorized_official_last_name": "MATTHEWS",
        "authorized_official_first_name": "ALIYA",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "609-922-1866",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "POD00148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.