Individual provider Active NPI

Daniel Wallace Mackie, P.T., D.P.T., O.C.S.

  • Physical Therapist
  • Canton, GA
National Provider Identifier
1851627079
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT009812 Issued in GA
Practice address
6768 Hickory Flat Hwy
Ste 110
Canton, GA 30115-9376
Phone
(770) 721-5767
Fax
(770) 345-0158
NPI assigned
Oct 22, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 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 PT009812 GA Primary

Addresses

Primary practice location

6768 Hickory Flat Hwy
Ste 110
Canton, GA 30115-9376

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 497-0005

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100507000085 GA Practitioner - Physical Therapist in Private Practice 7113055443 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
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)

1025 E W Connector
Suite 406
Austell, GA 30106-8531
Phone (770) 384-1001

6768 Hickory Flat Hwy
Suite 110
Canton, GA 30115-9376
Phone (770) 721-5767

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT009812GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Agilitas USA, Inc Physical Therapist CurrentSince Mar 21, 2025 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Dec 27, 2016 Accepting new patients
Agilitas USA Inc Physical Therapist CurrentSince Mar 21, 2025 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Dec 27, 2016 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

1025 E West Connector
Ste 406
Austell, GA 30106
Phone (770) 384-1001

6768 Hickory Flat Hwy
Ste 110
Canton, GA 30115
Phone (770) 704-8244

11490 Alpharetta Hwy
Ste 200
Roswell, GA 30076
Phone (770) 740-8592

6397 Lee Hwy
Ste 300
Chattanooga, TN 37421
Phone (423) 238-8923

8823 Production Ln
Ooltewah, TN 37363
Phone (423) 238-8923

Organizations & group practices 4

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": "1256169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1851627079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-497-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6768 HICKORY FLAT HWY",
            "address_2": "STE 110",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301159376",
            "telephone_number": "770-721-5767",
            "fax_number": "770-345-0158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKIE",
        "first_name": "DANIEL",
        "middle_name": "WALLACE",
        "credential": "P.T., D.P.T., O.C.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-22",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT009812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.