Provider Demographics
NPI:1285126441
Name:DJIRE, MARY CALDWELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CALDWELL
Last Name:DJIRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANNA
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
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:706-271-8540
Mailing Address - Fax:
Practice Address - Street 1:3790 PLEASANT HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5143
Practice Address - Country:US
Practice Address - Phone:770-497-4228
Practice Address - Fax:770-497-4474
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13325225100000X
GAPT013369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist