Healthcare Provider Details

I. General information

NPI: 1851285951
Provider Name (Legal Business Name): JORDON WALES PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2168 HIGHWAY 20 W
MCDONOUGH GA
30253-7205
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 470-944-7550
  • Fax: 470-944-7551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017737
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: