Provider Demographics
NPI:1770166100
Name:DJIRE, BILL ISSA BAKARY
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:ISSA BAKARY
Last Name:DJIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 PINERIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6540
Mailing Address - Country:US
Mailing Address - Phone:404-532-8714
Mailing Address - Fax:
Practice Address - Street 1:1201 MARKET STREET, SUITE A
Practice Address - Street 2:
Practice Address - City:CHATTANOOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-7081
Practice Address - Country:US
Practice Address - Phone:423-648-4490
Practice Address - Fax:423-648-4491
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist