Healthcare Provider Details

I. General information

NPI: 1275174153
Provider Name (Legal Business Name): JOOHI BUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 SPRING ST NW
ATLANTA GA
30308-1934
US

IV. Provider business mailing address

1315 RENAISSANCE WAY NE
ATLANTA GA
30308-2460
US

V. Phone/Fax

Practice location:
  • Phone: 404-881-1155
  • Fax:
Mailing address:
  • Phone: 860-402-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014122
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: