Healthcare Provider Details

I. General information

NPI: 1669529905
Provider Name (Legal Business Name): NORTH FULTON PHYSICAL THERAPY AND SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 FOUNDERS PKWY STE 126
ALPHARETTA GA
30009-7600
US

IV. Provider business mailing address

1750 FOUNDERS PKWY STE 126
ALPHARETTA GA
30009-7600
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-0727
  • Fax: 770-343-9607
Mailing address:
  • Phone: 770-442-0727
  • Fax: 770-343-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MALYNDA COPELAND
Title or Position: OPERATIONS MANAGER
Credential: LPN
Phone: 770-442-0727