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General NPI Number Information
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NPI Number | 1881551505
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Entity Type | Individual
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Provider Name | JAYME RUSSELL ZACHRY
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Gender | Female
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 1912 MEMORIAL DR STE G
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City | WAYCROSS
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State | GA
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Zip | 31501-0989
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Country | US
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Telephone | 912-427-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 6689 ROBERSON RD
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City | BLACKSHEAR
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State | GA
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Zip | 31516-5009
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018132
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License Number State | GA
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