MEDICARE: NICOLE CALKINS MCDONALD PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2014024675	MO
2	225100000X	Physical Therapist	PT011499	GA
3	225100000X	Physical Therapist	14999	NC
4	225100000X	Physical Therapist	08897R	LA
5	225100000X	Physical Therapist	10172	TN
6	225100000X	Physical Therapist	PTH7170	AL
7	225100000X	Physical Therapist	PT.014735	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102I656584	OTHER	AL	MEDICARE PTAN
2	361704YUZ5	OTHER	LA	MEDICARE PTAN
4	MA4370087	OTHER	MO	MEDICARE PTAN
8	361704YWWB	OTHER	LA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	511-51011	OTHER	AL	BCBS-WEST MADISON
5	511-50774	OTHER	AL	BCBS-ATHENS
6	511-51008	OTHER	AL	BCBS-HOOVER
7	USES NPI	OTHER	LA	BCBS-LA
9	511-51010	OTHER	AL	BCBS-MOODY
10	511-51009	OTHER	AL	BCBS-CHELSEA

General Provider Information

NPI Number	:	1427469865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CALKINS MCDONALD PT, DPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-362-8684

Provider Business Practice Location Address
First Line	:	60 EXCHANGE ST STE B4
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-7646
Country	:	US
Telephone Number	:	912-459-0072
Fax Number	:	912-459-0511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	05/24/2021

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