Healthcare Provider Details

I. General information

NPI: 1427831205
Provider Name (Legal Business Name): CAREY POYTHRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6884 HICKORY FLAT HWY
WOODSTOCK GA
30188-3229
US

IV. Provider business mailing address

709 CANTON RD NE STE 120
MARIETTA GA
30060-8971
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-8422
  • Fax:
Mailing address:
  • Phone: 770-792-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016780
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23703
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: