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General NPI Number Information
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NPI Number | 1588167266
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Entity Type | Individual
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Provider Name | JOHN LARRY OZOH DPT
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Gender | Male
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 201 EVERGREEN TER
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7375
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Country | US
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Telephone | 770-288-9334
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Fax |
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Provider Business Mailing Address
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Address Line | 2640 WESTBURY CT
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City | SUWANEE
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State | GA
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Zip | 30024-3178
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Country | US
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Telephone | 678-499-2172
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Fax | 770-910-9792
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT005377
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License Number State | GA
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