Individual
DONALD CALDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
602 REVILLION WAY, WOODSTOCK, GA 30188-7090
(770) 516-8393
Mailing address
602 REVILLION WAY, WOODSTOCK, GA 30188
(770) 516-8393
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002073
GA
Other
Enumeration date
03/10/2011
Last updated
03/10/2011
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