Provider Demographics
NPI:1912592478
Name:GILCHRIST, SYNETHA BENNETT
Entity Type:Individual
Prefix:
First Name:SYNETHA
Middle Name:BENNETT
Last Name:GILCHRIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PERIMETER CTR E APT 1213
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1657
Mailing Address - Country:US
Mailing Address - Phone:770-286-5430
Mailing Address - Fax:
Practice Address - Street 1:655 MANSELL RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4868
Practice Address - Country:US
Practice Address - Phone:770-643-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist