Healthcare Provider Details

I. General information

NPI: 1811821929
Provider Name (Legal Business Name): JARED SCOTT CARLSON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 NEWNAN CROSSING BLVD E
NEWNAN GA
30265-2575
US

IV. Provider business mailing address

1999 BERTHA CT
LOVEJOY GA
30228-4006
US

V. Phone/Fax

Practice location:
  • Phone: 678-663-6600
  • Fax:
Mailing address:
  • Phone: 585-409-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA004865
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: