Klaytin Marcus Fann, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT013630 Issued in GA

Practice address

6768 Hickory Flat Hwy Ste 110
Canton, GA 30115

Phone

(770) 721-5767

Fax

(770) 345-0158

NPI assigned

Jul 26, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Independent Physical Therapy of Georgia, LLCGroup PAC ID 2961312244, 526 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Independent Physical Therapy of Georgia, LLC

  dba BenchMark Physical Therapy

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  Medicare reassignment Care Compare group NPD
• Independent Physical Therapy of Georgia, LLC

  dba Benchmark PT

  • Occupational Therapist
  • Gainesville, GA
  • NPI 1306013941

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534464000000",
    "number": "1275010803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212564",
            "telephone_number": "423-238-7217",
            "fax_number": "423-362-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6768 HICKORY FLAT HWY STE 110",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30115",
            "telephone_number": "770-721-5767",
            "fax_number": "770-345-0158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANN",
        "first_name": "KLAYTIN",
        "middle_name": "MARCUS",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-26",
        "last_updated": "2018-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT013630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Exos - Athletes Performance Arizona LLC
• Exos Ap Arizona, LLC
• Nnenna Ezeilo, M.D.
• Fairpricemd Inc (FairPriceLabs)
• Family First Vision Care Georgia PLLC (Pearle Vision)
• Jill Fannin, M.ED., CCC-SLP
• Kayla Farabaugh, LCSW
• Joilahna Farnsworth
• Chelsea Marie Farr
• Carly Marie Farrell, LCSW

• Physical Therapist in Canton, GA
• Providers in Canton, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.