Provider Demographics
NPI:1306108196
Name:SANDLIN, JESSE NEAL (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:NEAL
Last Name:SANDLIN
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 DOWDY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5700
Mailing Address - Country:US
Mailing Address - Phone:706-389-8941
Mailing Address - Fax:706-389-8942
Practice Address - Street 1:1061 DOWDY RD STE 202
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5700
Practice Address - Country:US
Practice Address - Phone:706-389-8941
Practice Address - Fax:706-389-8942
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0020412255A2300X
GA10538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer