Provider Demographics
NPI:1215557921
Name:GESITE, CARLY CEE WITT (MS, PT, CNDT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:CEE WITT
Last Name:GESITE
Suffix:
Gender:F
Credentials:MS, PT, CNDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MILLSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6139
Mailing Address - Country:US
Mailing Address - Phone:404-216-9620
Mailing Address - Fax:
Practice Address - Street 1:11785 NORTHFALL LN STE 501&502
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7971
Practice Address - Country:US
Practice Address - Phone:770-569-2274
Practice Address - Fax:678-899-6333
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0084962251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
14654277OtherCAQH