Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT013400 | GA |
NPI | 1003300708 |
---|---|
Provider Name | Jacob C Flint |
First Address | Jefferson, GA 30549-2666 |
Second Address | Jefferson, GA 30549-2666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 18/06/2018 |