Healthcare Provider Details

I. General information

NPI: 1629289715
Provider Name (Legal Business Name): MEADOWS CLINIC AT LAWRENCEVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 FIVE FORKS TRICKUM RD STE 210
LAWRENCEVILLE GA
30044-8183
US

IV. Provider business mailing address

1430 FIVE FORKS TRICKUM RD STE 210
LAWRENCEVILLE GA
30044-8183
US

V. Phone/Fax

Practice location:
  • Phone: 678-377-1738
  • Fax: 678-377-1737
Mailing address:
  • Phone: 678-377-1738
  • Fax: 378-377-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004486
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005934
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT004486
License Number StateGA

VIII. Authorized Official

Name: MANISHA KAPASI
Title or Position: PRESIDENT
Credential: PT, PHD, CHT
Phone: 770-623-0105