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General NPI Number Information
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NPI Number | 1730055989
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Entity Type | Individual
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Provider Name | MARTHA THOMAS MCGOURK PTA
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Gender | Female
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 5901 PEACHTREE DUNWOODY RD
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City | ATLANTA
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State | GA
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Zip | 30328-5382
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Country | US
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Telephone | 678-442-7861
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Fax |
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Provider Business Mailing Address
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Address Line | 1334 OAK GROVE DR
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City | DECATUR
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State | GA
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Zip | 30033-2037
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Country | US
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Telephone | 404-663-3276
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA1466
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License Number State | GA
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