Provider Demographics
NPI:1194175141
Name:STOCKS, JENNIFER L (PT,DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:STOCKS
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MIRROR LAKE BLVD STE S
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2126
Mailing Address - Country:US
Mailing Address - Phone:770-456-7877
Mailing Address - Fax:770-456-7880
Practice Address - Street 1:500 NATHAN DEAN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-4912
Practice Address - Country:US
Practice Address - Phone:678-402-7770
Practice Address - Fax:678-402-6947
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT012390OtherPT LICENSE
GA003185761Medicaid