Provider Demographics
NPI:1255366258
Name:MCCANTS, CLAUDE (PT)
Entity type:Individual
Prefix:
First Name:CLAUDE
Middle Name:
Last Name:MCCANTS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 TERRACE GREEN TRCE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5240 SNAPFINGER PARK DR
Practice Address - Street 2:SUITE 130
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4059
Practice Address - Country:US
Practice Address - Phone:770-322-7003
Practice Address - Fax:770-322-7630
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAATC0003922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52288042-010OtherBCBS OF GA