LYDIA MIKULA CLACKUM (DPT) – Physical Therapist, NPI 1295228781

Physical Therapist

LYDIA MIKULA CLACKUM (DPT) is a healthcare provider. based in Loganville, Georgia. specializing in Physical Therapist. They hold the professional credentials DPT. They hold a License No. PT013374 (GA). The NPI Number for LYDIA MIKULA CLACKUM (DPT) is 1295228781

Main info

Female

8 Years Of Experience

Accepts Medicare Assignment

Name

LYDIA MIKULA CLACKUM (DPT)

NPI

1295228781

Phone

(770) 554-0665

Address

3455 HIGHWAY 81 SOUTH

Enumeration Date

11 June 2018

Last Update Date

11 June 2018

Doctor Profile

Medical School Name

OTHER

Secondary Phone

4704441609

Graduation Year

2018 (8 years ago)

PAC ID

8527318047

Group Practice PAC ID

4284863317

Professional Enrollment ID

I20180904003553

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience28

Completeness75

Years active:7State licenses:1Digital endpointsOther names

Provider Addresses for LYDIA MIKULA CLACKUM (DPT)

3455 HIGHWAY 81 SOUTH
LOGANVILLE, GA 300523918
Phone: (770) 554-0665
Fax: (770) 554-0685
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 30052)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 4284863317View full group profile

Name	Specialty	State
AMY NEWBERRY (PT, DPT)	-	GA
WESLEY ADAM SPAKE (PT, DPT)	-	GA
MATTHEW E OTEY (PT, DT, CERT DN)	-	GA
MR. COLBY MARSHALL ALLEN (MPT)	-	GA
ANSLEY HEAD FERGUSON (PT, DPT)	-	GA
LAURA SMITH MCMURRAIN (PT, MPT)	-	GA
PATRICK THOMPSON	-	AL