Healthcare Provider Details

I. General information

NPI: 1396087896
Provider Name (Legal Business Name): ALYSON KIRKLAND O'BANION MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W WHEELER PKWY SUITE E
AUGUSTA GA
30909-6625
US

IV. Provider business mailing address

1220 W WHEELER PKWY SUITE E
AUGUSTA GA
30909-6625
US

V. Phone/Fax

Practice location:
  • Phone: 706-446-1399
  • Fax: 706-210-2036
Mailing address:
  • Phone: 706-446-1399
  • Fax: 706-210-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006389
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3853
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: