MEDICARE: CARSON HAGAN DPT

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	PT017141	GA

General Provider Information

NPI Number	:	1871423533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARSON HAGAN DPT

Provider Business Mailing Address
First Line	:	1282 OAK GROVE AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1618
Country	:	US
Telephone Number	:	912-704-2477
Fax Number	:

Provider Business Practice Location Address
First Line	:	1282 OAK GROVE AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1618
Country	:	US
Telephone Number	:	912-704-2477
Fax Number	:

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

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ CARSON HAGAN DPT” Practice Location

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