MEDICARE: EDDIE D. COVERSON P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT0007026	GA

General Provider Information

NPI Number	:	1376559856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDIE D. COVERSON P.T.

Provider Business Mailing Address
First Line	:	900 CIRCLE 75 PKWY SE
Second Line	:	SUITE 1700
City	:	ATLANTA
State	:	GA
Zip	:	30339-3035
Country	:	US
Telephone Number	:	770-953-6929
Fax Number	:	770-953-6972

Provider Business Practice Location Address
First Line	:	6002 PROFESSIONAL PKWY
Second Line	:	SUITE 140
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5600
Country	:	US
Telephone Number	:	770-949-8558
Fax Number	:	770-949-6966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	01/13/2015

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