NPI Code Detail JSON Logo

1588083331 NPI number — MICHAEL GEVONTMAKHER DPT

NPI Number: 1588083331
Health Care Provider/Practitioner: MICHAEL GEVONTMAKHER DPT

Information about “1588083331” NPI (MICHAEL GEVONTMAKHER DPT) exists in 1588083331 in HTML format HTML  |  1588083331 in plain Text format TXT  |  1588083331 in PDF (Portable Document Format) PDF  |  1588083331 in an XML format XML  formats.

NPI Number : 1588083331 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588083331",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GEVONTMAKHER",
    "FirstName": "MICHAEL",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "125 TERRAMONT CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSWELL",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30076-2527",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "786-628-9186",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1000 JOHNSON FERRY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ATLANTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30342-1606",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "404-851-8912",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/09/2014",
    "LastUpdateDate": "08/13/2020",
    "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": "PT011183",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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