Healthcare Provider Details

I. General information

NPI: 1922588037
Provider Name (Legal Business Name): RYAN JOSEPH J. MUSSELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 S 8TH ST STE D
GRIFFIN GA
30224-4884
US

IV. Provider business mailing address

317 ETHERIDGE MILL RD
MILNER GA
30257-3782
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6498
  • Fax:
Mailing address:
  • Phone: 678-603-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013624
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: