Healthcare Provider Details

I. General information

NPI: 1326372384
Provider Name (Legal Business Name): JACQUELINE ERICKSON BUSS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE ERICKSON PT

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 DALLAS HWY STE 270
POWDER SPRINGS GA
30127-6296
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 770-485-3203
  • Fax:
Mailing address:
  • Phone: 423-702-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4895
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: