Healthcare Provider Details

I. General information

NPI: 1518024991
Provider Name (Legal Business Name): JON MICHAEL PRESTON M.S.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 PEACHTREE INDUSTRIAL BLVD SUITE 130
DULUTH GA
30097-8180
US

IV. Provider business mailing address

2557 COLLINS PORT CV
SUWANEE GA
30024-2787
US

V. Phone/Fax

Practice location:
  • Phone: 770-232-7100
  • Fax: 770-232-7198
Mailing address:
  • Phone: 770-232-7100
  • Fax: 770-232-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006667
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: