Provider Demographics
NPI:1023613197
Name:DUNCAN, JAVIS (DPT)
Entity type:Individual
Prefix:
First Name:JAVIS
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JARVIS
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 1700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3087
Mailing Address - Country:US
Mailing Address - Phone:678-673-5134
Mailing Address - Fax:
Practice Address - Street 1:620 CHEROKEE ST NE STE 300
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7233
Practice Address - Country:US
Practice Address - Phone:770-635-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist