Provider Demographics
NPI:1780472050
Name:DENNIS, GAVIN KEITH (DPT)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:KEITH
Last Name:DENNIS
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5368 NEW FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:HOGANSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30230-2414
Mailing Address - Country:US
Mailing Address - Phone:706-817-6035
Mailing Address - Fax:
Practice Address - Street 1:3540 COBB PKWY NW STE 300
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4179
Practice Address - Country:US
Practice Address - Phone:678-501-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist