MEDICARE: MRS. HOLLY MOORE ATKINSON MPT

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	PT007311	GA

General Provider Information

NPI Number	:	1750650362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY MOORE ATKINSON MPT

Provider Business Mailing Address
First Line	:	730 CLUBSIDE DR
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 CLUBSIDE DR
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2006
Country	:	US
Telephone Number	:	404-543-4300
Fax Number	:

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

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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