=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487542031
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET GRACE WELCH DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2025
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 JOHNSON FERRY PL STE G10
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30068-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-321-6705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2831 FOREST CHASE DR NE
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-1459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-564-9672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT017790
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------