Healthcare Provider Details

I. General information

NPI: 1033265319
Provider Name (Legal Business Name): JEFFREY EBERT P.T., D.P.T., O.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 MERCER UNIVERSITY DR
ATLANTA GA
30341-4115
US

IV. Provider business mailing address

4634 FITZPATRICK WAY
PEACHTREE CORNERS GA
30092-1004
US

V. Phone/Fax

Practice location:
  • Phone: 678-547-6549
  • Fax:
Mailing address:
  • Phone: 402-981-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2226
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT011222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: