Healthcare Provider Details

I. General information

NPI: 1225990963
Provider Name (Legal Business Name): ASCENSION PHYSICAL THERAPY AND PERFORMANCE INSTITUTE OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL STE N
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

PO BOX 251
FAIRBURN GA
30213-0251
US

V. Phone/Fax

Practice location:
  • Phone: 706-604-4868
  • Fax:
Mailing address:
  • Phone: 706-604-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. QUINTON TYLER BUCKNER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 706-604-4868