Provider Demographics
NPI:1730149477
Name:DOSS, POLLY W (PT)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:W
Last Name:DOSS
Suffix:
Gender:F
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:PO BOX 1482
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1426
Mailing Address - Country:US
Mailing Address - Phone:706-491-5261
Mailing Address - Fax:
Practice Address - Street 1:2204 OAK VALLEY RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-9508
Practice Address - Country:US
Practice Address - Phone:706-491-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00805296BMedicaid