Healthcare Provider Details

I. General information

NPI: 1447618426
Provider Name (Legal Business Name): MICHAEL DRISCOLL WITTER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PLEASANT HILL RD STE 130
DULUTH GA
30096-1407
US

IV. Provider business mailing address

3855 PLEASANT HILL RD STE 130
DULUTH GA
30096-1407
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-7880
  • Fax: 678-312-7890
Mailing address:
  • Phone: 678-312-7880
  • Fax: 678-312-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62 039916
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017042
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21211
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: