Mary Caldwell Djire, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT013369 Issued in GA

Practice address

3790 Pleasant Hill Rd Ste 100
Duluth, GA 30096-5143

Phone

(770) 497-4228

Fax

(770) 497-4474

NPI assigned

Jun 4, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mary Anna Caldwell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1285126441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4477 PINERIDGE CIR",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303386540",
            "telephone_number": "706-271-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3790 PLEASANT HILL RD STE 100",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965143",
            "telephone_number": "770-497-4228",
            "fax_number": "770-497-4474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 E Ocean Ave",
            "address_purpose": "LOCATION",
            "city": "Lompoc",
            "state": "CA",
            "postal_code": "934367081",
            "country_code": "US",
            "telephone_number": "805-735-8365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DJIRE",
        "first_name": "MARY",
        "middle_name": "CALDWELL",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-04",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "13325",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT013369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "CALDWELL",
            "middle_name": "ANNA",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.