Individual provider Active NPI

Amari Black

  • Physical Therapist
  • Carrollton, GA
National Provider Identifier
1497627897
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT018031 Issued in GA
Practice address
812 S Park St Ste 1
Carrollton, GA 30117-4412
Phone
(770) 834-7436
NPI assigned
Sep 23, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT018031 GA Primary

Addresses

Primary practice location

812 S Park St Ste 1
Carrollton, GA 30117-4412

Mailing address

812 S Park St Ste 1
Carrollton, GA 30117-4412
Phone (770) 834-7436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251209000576 GA Practitioner - Physical Therapist in Private Practice 9739673708 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Orthopedic Rehab LLCGroup PAC ID 0042666836, 4 clinicians

Practice addresses (Care Compare)

2462 Hwy 34 E
Suite E
Newnan, GA 30265-2378
Phone (229) 886-7400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT018031GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Orthopedic Rehab LLC Physical Therapist CurrentSince Nov 3, 2025 Accepting new patients

Locations

2462 Highway 34 E
Ste E
Newnan, GA 30265
Phone (229) 886-7400

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1758585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1497627897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 S PARK ST STE 1",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174412",
            "telephone_number": "770-834-7436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 S PARK ST STE 1",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174412",
            "telephone_number": "770-834-7436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "AMARI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-23",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT018031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.