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NPI Code Detail

MEDICARE: JEANNETTE RENEE ANDERSON PT

MEDICARE: JEANNETTE RENEE ANDERSON 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 TherapistPT007386GA

General Provider Information

NPI Number : 1689740011
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNETTE RENEE ANDERSON PT
Provider Business Mailing Address
First Line : 3001 MERCER UNIVERSITY DR
Second Line : DAVIS SUITE 100
City : ATLANTA
State : GA
Zip : 30341-4115
Country : US
Telephone Number : 678-547-6247
Fax Number : 678-547-6202
Provider Business Practice Location Address
First Line : 3001 MERCER UNIVERSITY DR
Second Line : DAVIS SUITE 100
City : ATLANTA
State : GA
Zip : 30341-4115
Country : US
Telephone Number : 678-547-6247
Fax Number : 678-547-6202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 02/08/2011

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Directions to “ JEANNETTE RENEE ANDERSON PT” Practice Location

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