Healthcare Provider Details

I. General information

NPI: 1205544665
Provider Name (Legal Business Name): NOELLE OHARA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2983 CHAPEL HILL RD STE 106
DOUGLASVILLE GA
30135-1767
US

IV. Provider business mailing address

2000 MIRROR LAKE BLVD STE S
VILLA RICA GA
30180-2126
US

V. Phone/Fax

Practice location:
  • Phone: 770-947-8177
  • Fax:
Mailing address:
  • Phone: 770-456-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016341
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: