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General NPI Number Information
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NPI Number | 1033665302
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Entity Type | Individual
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Provider Name | JESSICA HAWKES MANN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 1111 LOWER FAYETTEVILLE RD STE 2000
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City | NEWNAN
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State | GA
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Zip | 30265-6506
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Country | US
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Telephone | 770-251-7284
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Fax | 770-251-7295
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Provider Business Mailing Address
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Address Line | 1755 HIGHWAY 34 E STE 1300
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City | NEWNAN
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State | GA
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Zip | 30265-3186
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Country | US
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Telephone | 770-254-7850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT012509
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License Number State | GA
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