Active NPI
Luke Robert Mauldin, PTA
- Physical Therapy Assistant
- Braselton, GA
National Provider Identifier
1760905988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA003863
- Practice address
- 1241 Friendship Rd Ste 120
Braselton, GA 30517-5609 - Phone
- (770) 415-9792
- Fax
- (770) 882-0268
- NPI assigned
- Jul 19, 2017
- 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 Therapy Assistant | 225200000X | PTA003863 | GA | Primary |
Addresses
Primary practice location
1241 Friendship Rd Ste 120
Braselton, GA 30517-5609
Mailing address
PO Box 5545
Augusta, GA 30916-5545
Phone (803) 441-0025
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA003863 | Other | GA | PTA LICENSE NUMBER |
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 |
|---|---|---|---|
| PTA003863 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1760905988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5545",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309165545",
"telephone_number": "803-441-0025",
"fax_number": "803-441-0031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1241 FRIENDSHIP RD STE 120",
"city": "BRASELTON",
"state": "GA",
"postal_code": "305175609",
"telephone_number": "770-415-9792",
"fax_number": "770-882-0268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAULDIN",
"first_name": "LUKE",
"middle_name": "ROBERT",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-19",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA003863",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE NUMBER",
"identifier": "PTA003863",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Braselton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.