Provider Demographics
NPI:1124233374
Name:SASSER, JIMMIE SUE (ATC)
Entity type:Individual
Prefix:
First Name:JIMMIE SUE
Middle Name:
Last Name:SASSER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:JIMMIE SUE
Other - Middle Name:
Other - Last Name:WIMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:129 SOUTH RAILROAD AVENUE
Mailing Address - Street 2:POST OFFICE BOX 411
Mailing Address - City:MT. VERNON
Mailing Address - State:GA
Mailing Address - Zip Code:30445
Mailing Address - Country:US
Mailing Address - Phone:912-583-2020
Mailing Address - Fax:
Practice Address - Street 1:1235 JASMINE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-0841
Practice Address - Country:US
Practice Address - Phone:912-583-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT 0003522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer