Provider Demographics
NPI:1326486796
Name:SMITH, MARGARET VARNADO (PT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:VARNADO
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:V
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:5388 BURDETTE RD SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2646
Mailing Address - Country:US
Mailing Address - Phone:404-226-0520
Mailing Address - Fax:
Practice Address - Street 1:3680 HIGHLANDS PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:770-989-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I654894OtherMEDICARE PTAN