=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497159057
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN MICHAEL CARAWAY DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2014
-----------------------------------------------------
Last Update Date | 03/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3540 COBB PKWY NW
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30101-4178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-501-6300
-----------------------------------------------------
Fax | 678-721-7799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 TECHNACENTER DR SUITE 300
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-6028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-625-5795
-----------------------------------------------------
Fax | 334-396-4905
-----------------------------------------------------
=====================================================
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 | PT011378
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------