Healthcare Provider Details

I. General information

NPI: 1376559856
Provider Name (Legal Business Name): EDDIE D. COVERSON P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 PROFESSIONAL PKWY SUITE 140
DOUGLASVILLE GA
30134-5600
US

IV. Provider business mailing address

900 CIRCLE 75 PKWY SE SUITE 1700
ATLANTA GA
30339-3035
US

V. Phone/Fax

Practice location:
  • Phone: 770-949-8558
  • Fax: 770-949-6966
Mailing address:
  • Phone: 770-953-6929
  • Fax: 770-953-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0007026
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: