Healthcare Provider Details

I. General information

NPI: 1538299474
Provider Name (Legal Business Name): KURT ANTHONY MCDONALD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 REDWINE RD SW SUITE 114
ATLANTA GA
30331-5582
US

IV. Provider business mailing address

3890 REDWINE RD SW SUITE 114
ATLANTA GA
30331-5582
US

V. Phone/Fax

Practice location:
  • Phone: 404-344-7880
  • Fax: 404-344-7881
Mailing address:
  • Phone: 404-344-7880
  • Fax: 404-344-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number006133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: