Active NPI
Martha Pennell
- Physical Therapy Assistant
- Suwanee, GA
National Provider Identifier
1326797515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA004810
- Practice address
- 2576 Lawrenceville Suwanee Rd
Suwanee, GA 30024-7290 - Phone
- (770) 962-4043
- NPI assigned
- Mar 23, 2022
- Sex
- Female
- 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 Therapy Assistant | 225200000X | PTA004810 | GA | Primary |
Addresses
Primary practice location
2576 Lawrenceville Suwanee Rd
Suwanee, GA 30024-7290
Mailing address
2997 Northbrook Dr
Doraville, GA 30340-4321
Phone (404) 375-2836
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA004810 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647993600000",
"number": "1326797515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2997 NORTHBROOK DR",
"city": "DORAVILLE",
"state": "GA",
"postal_code": "303404321",
"telephone_number": "404-375-2836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2576 LAWRENCEVILLE SUWANEE RD",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300247290",
"telephone_number": "770-962-4043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNELL",
"first_name": "MARTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-23",
"last_updated": "2022-03-23",
"certification_date": "2022-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA004810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suwanee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.