Provider Demographics
NPI:1891473955
Name:LAYMAC, MICHAEL MILLER I (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MILLER
Last Name:LAYMAC
Suffix:I
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 LANIER HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9129
Mailing Address - Country:US
Mailing Address - Phone:678-736-1055
Mailing Address - Fax:
Practice Address - Street 1:3000 CELEBRATION BLVD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1054
Practice Address - Country:US
Practice Address - Phone:404-991-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004771225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant