Healthcare Provider Details

I. General information

NPI: 1134026578
Provider Name (Legal Business Name): JASON HOWARD PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2026
Last Update Date: 10/20/2026
Certification Date: 10/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 VERNON RD
LAGRANGE GA
30240-4041
US

IV. Provider business mailing address

1801 VERNON RD
LAGRANGE GA
30240-4041
US

V. Phone/Fax

Practice location:
  • Phone: 404-544-1813
  • Fax: 706-882-1544
Mailing address:
  • Phone: 404-544-1813
  • Fax: 706-882-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA001600
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: