Individual
MS. COURTNEY HANCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
545 OLD NORCROSS RD, STE. 100, LAWRENCEVILLE, GA 30046-3389
(678) 377-2833
(678) 377-2882
Mailing address
2297 YOUNG AMERICA DR, LAWRENCEVILLE, GA 30043-8012
(678) 417-6375
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT006386
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00827736A
—
GA
01
—
10037629
AMERIGROUP PROVIDER #
GA
01
—
307924
WELLCARE PROVIDER #
GA
Enumeration date
12/11/2006
Last updated
10/07/2010
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