Individual
LUKE ROBERT MAULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1241 FRIENDSHIP RD STE 120, BRASELTON, GA 30517-5609
(770) 415-9792
(770) 882-0268
Mailing address
PO BOX 5545, AUGUSTA, GA 30916-5545
(803) 441-0025
(803) 441-0031
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA003863
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA003863
PTA LICENSE NUMBER
GA
Enumeration date
07/19/2017
Last updated
06/11/2019
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