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NPI Code Detail

MEDICARE: GEORGIA J DENTON MSPT, MTC

MEDICARE: GEORGIA J DENTON MSPT, MTC
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
1225100000XPhysical TherapistPT007629GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT007629OTHERGASTATE LISC NUMBER

General Provider Information

NPI Number : 1982773826
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGIA J DENTON MSPT, MTC
Provider Business Mailing Address
First Line : 1515 JOHNSON FERRY RD STE 200
Second Line :
City : MARIETTA
State : GA
Zip : 30062-6492
Country : US
Telephone Number : 470-210-7222
Fax Number :
Provider Business Practice Location Address
First Line : 1515 JOHNSON FERRY RD STE 200
Second Line :
City : MARIETTA
State : GA
Zip : 30062-6492
Country : US
Telephone Number : 470-210-7222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 11/08/2022

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