Healthcare Provider Details

I. General information

NPI: 1376469601
Provider Name (Legal Business Name): MAKENNA DOHERTY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 MCGINNIS FERRY RD STE 111
JOHNS CREEK GA
30097-3521
US

IV. Provider business mailing address

6955 MCGINNIS FERRY RD STE 111
JOHNS CREEK GA
30097-3521
US

V. Phone/Fax

Practice location:
  • Phone: 770-573-1972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018404
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: