=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699222091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDI DOTSON PT, DPT, MBA, OCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2016
-----------------------------------------------------
Last Update Date | 12/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1812 POWDER SPRINGS RD SW STE 2101
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30064-4384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-528-1704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3708 GARDENWICK RD
-----------------------------------------------------
City | POWDER SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30127-5668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-353-8755
-----------------------------------------------------
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 | PT012361
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------