Active NPI
Laura Sullivan Fenton
- Physical Therapist
- Woodstock, GA
National Provider Identifier
1992389241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT014284
- Practice address
- 2001 Professional Pkwy Ste 220
Woodstock, GA 30188-6444 - Phone
- (844) 543-8437
- NPI assigned
- May 11, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225100000X | PT014284 | GA | Primary |
Addresses
Primary practice location
2001 Professional Pkwy Ste 220
Woodstock, GA 30188-6444
Mailing address
293 Creekridge Cir NW
Acworth, GA 30102-6903
Phone (229) 328-5371
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 |
|---|---|---|---|
| PT014284 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621209600000",
"number": "1992389241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "293 CREEKRIDGE CIR NW",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301026903",
"telephone_number": "229-328-5371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 PROFESSIONAL PKWY STE 220",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301886444",
"telephone_number": "844-543-8437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENTON",
"first_name": "LAURA",
"middle_name": "SULLIVAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-11",
"last_updated": "2021-05-17",
"certification_date": "2021-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT014284",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.