Provider Demographics
NPI:1376559856
Name:COVERSON, EDDIE D (PT)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:D
Last Name:COVERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:6002 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5600
Practice Address - Country:US
Practice Address - Phone:770-949-8558
Practice Address - Fax:770-949-6966
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0007026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA360439914OtherOWCP
GA008214738OtherAETN
GA52843036-005OtherBCBS