=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821432014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL CURTIS BROOKSHIRE PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2013
-----------------------------------------------------
Last Update Date | 07/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 PRIME HILL DR
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30525-4249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-364-2344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1218 N MAIN STREET
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30525-4799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-782-2585
-----------------------------------------------------
Fax | 706-782-2112
-----------------------------------------------------
=====================================================
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 | 006121
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------