Individual
DEIRDRE DOLAN DOUGLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
586 CLUBLAND CIR SE, CONYERS, GA 30094-3626
(770) 785-7908
(770) 785-7908
Mailing address
586 CLUBLAND CIR SE, CONYERS, GA 30094-3626
(770) 785-7908
(770) 785-7908
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT003272
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000711763B
—
GA
05
—
10057878
—
GA
05
—
322094
—
GA
Enumeration date
12/11/2006
Last updated
09/17/2012
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