Healthcare Provider Details

I. General information

NPI: 1508785478
Provider Name (Legal Business Name): JONIAH HINES MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 SHORTER AVE NW STE 101
ROME GA
30165-4289
US

IV. Provider business mailing address

304 SHORTER AVE NW STE 101
ROME GA
30165-4289
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: