Healthcare Provider Details

I. General information

NPI: 1659287845
Provider Name (Legal Business Name): ERW CIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 TOWN PARK BLVD
EVANS GA
30809-3487
US

IV. Provider business mailing address

415 TOWN PARK BLVD
EVANS GA
30809-3487
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-1707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JASON LOTT
Title or Position: OWNER/PT
Credential:
Phone: 706-868-1707