Active NPI
Justin Desandre
- Physical Therapist
- Acworth, GA
National Provider Identifier
1003392903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 4900 Ivey Rd NW Ste 1001
Acworth, GA 30101-4106 - Phone
- (770) 917-0924
- NPI assigned
- Jul 13, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
4900 Ivey Rd NW Ste 1001
Acworth, GA 30101-4106
Mailing address
PO Box 724557
Atlanta, GA 31139-1557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531440000000",
"number": "1003392903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 724557",
"city": "ATLANTA",
"state": "GA",
"postal_code": "311391557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4900 IVEY RD NW STE 1001",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301014106",
"telephone_number": "770-917-0924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESANDRE",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-13",
"last_updated": "2018-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.