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General NPI Number Information
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NPI Number | 1467870402
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Entity Type | Individual
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Provider Name | ALEXIS JARVIS
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Gender | Female
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Dates
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Enumeration Date | 04/05/2014
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Last Update Date | 04/05/2014
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Provider Practice Location Address
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Address Line | 5673 PEACHTREE DUNWOODY RD
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City | ATLANTA
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State | GA
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Zip | 30342-1731
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Country | US
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Telephone | 706-244-5252
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 SPRING CREEK LN
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-3848
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000012639
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License Number State | GA
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