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1376475632 NPI number — EDDISON VERRETT PT, DPT

NPI Number: 1376475632
Health Care Provider/Practitioner: EDDISON VERRETT PT, DPT

Information about “1376475632” NPI (EDDISON VERRETT PT, DPT) exists in 1376475632 in HTML format HTML  |  1376475632 in plain Text format TXT  |  1376475632 in PDF (Portable Document Format) PDF  |  1376475632 in an XML format XML  formats.

NPI Number : 1376475632 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376475632",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VERRETT",
    "FirstName": "EDDISON",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VERRETT",
    "OtherFirstName": "TRE",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PT, DPT",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1100 LASSIE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAIRBURN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30213-7008",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-733-7720",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "450 N CANDLER ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DECATUR",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30030-2626",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "404-501-6136",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/01/2026",
    "LastUpdateDate": "06/04/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "PT018291",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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