MEDICARE: JEFFREY WILLIAM SPRAKER D.P.T.

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
1	225100000X	Physical Therapist	PT015303	GA

General Provider Information

NPI Number	:	1740858505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WILLIAM SPRAKER D.P.T.

Provider Business Mailing Address
First Line	:	2800 N DRUID HILLS RD NE STE A100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3921
Country	:	US
Telephone Number	:	470-427-3840
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 N DRUID HILLS RD NE STE A100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3921
Country	:	US
Telephone Number	:	470-427-3840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/16/2021

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