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NPI Code Detail

MEDICARE: JORDAN D MELLINGER PT

MEDICARE: JORDAN D MELLINGER PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistAT001719GA

General Provider Information

NPI Number : 1669737771
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN D MELLINGER PT
Provider Business Mailing Address
First Line : PO BOX 370
Second Line :
City : FORTSON
State : GA
Zip : 31808-0370
Country : US
Telephone Number : 706-494-3071
Fax Number :
Provider Business Practice Location Address
First Line : 1220 W WHEELER PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6625
Country : US
Telephone Number : 706-869-1515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2012
Last Update Date : 06/10/2024

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