Divine Podiatry Center LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

DIVINE PODIATRY CENTER LLC

Practice address

1204 Bentley Estates Dr
Dacula, GA 30019-7786

Phone

(609) 922-8166

NPI assigned

Dec 19, 2018

Last updated

Apr 18, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Aliya Matthews, DPMNPI 1487819173

Title

Owner

Phone

(609) 922-1866

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Aliya Matthews, DPM

  • Podiatrist
  • Dacula, GA
  • NPI 1487819173
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587168000000",
    "number": "1528530268",
    "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"
        },
        {
            "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": "609-922-8166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PODIATRY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-19",
        "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": "OWNER",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meekerley Destin, MSN, PMHNP-BC
• Lucy L Dexter, SLP
• Anthony John Didato Jr.
• Divine Hope Home Care LLC
• Divine Podiatry
• Ann-Marie D Dixon, FNP-BC
• A Y Dixson
• Andrew Dold, D.O.
• Rosemary Donahue
• Heather Doran

• Podiatrist in Dacula, GA
• Providers in Dacula, GA by specialty
• Podiatrist in Georgia

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.