Healthcare Provider Details

I. General information

NPI: 1225129638
Provider Name (Legal Business Name): ATLANTA PHYSICAL THERAPY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD NE SUITE 1040
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

709 OLD BURTON RD
CLARKESVILLE GA
30523-1142
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-7513
  • Fax: 706-947-0109
Mailing address:
  • Phone: 706-947-1058
  • Fax: 706-947-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1093
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1093
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1093
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1093
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number1093
License Number StateGA

VIII. Authorized Official

Name: MS. BAMBI J WOMACK
Title or Position: CEO
Credential: PT
Phone: 404-252-7513