Provider Demographics
NPI:1215318514
Name:NAAB, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:NAAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TOWN PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3471
Mailing Address - Country:US
Mailing Address - Phone:706-854-9850
Mailing Address - Fax:
Practice Address - Street 1:400 TOWN PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3471
Practice Address - Country:US
Practice Address - Phone:706-854-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209501225100000X
GAPT011952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist