Active NPI
William Kovalczyk, DPM
- Podiatrist
- Grayson, GA
National Provider Identifier
1174504872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 684
- Practice address
- 148 Mission Oak Dr
Grayson, GA 30017-4153 - Phone
- (678) 376-5714
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 684 | GA | Primary |
Addresses
Primary practice location
148 Mission Oak Dr
Grayson, GA 30017-4153
Mailing address
PO Box 846
Snellville, GA 30078-0846
Phone (678) 376-5714
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00521474A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 684 | GA | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297036800000",
"number": "1174504872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 846",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300780846",
"telephone_number": "678-376-5714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "148 MISSION OAK DR",
"city": "GRAYSON",
"state": "GA",
"postal_code": "300174153",
"telephone_number": "678-376-5714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOVALCZYK",
"first_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-09",
"last_updated": "2011-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "GA",
"license": "684",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00521474A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grayson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.