Provider Demographics
NPI:1306255518
Name:JARRIEL, AMANDA JACKSON (PHD, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JACKSON
Last Name:JARRIEL
Suffix:
Gender:F
Credentials:PHD, ATC, LAT
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Mailing Address - Street 1:231 WEST HANCOCK STREET CAMPUS BOX 112
Mailing Address - Street 2:GEORGIA COLLEGE
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061
Mailing Address - Country:US
Mailing Address - Phone:478-445-2136
Mailing Address - Fax:478-445-4074
Practice Address - Street 1:231 WEST HANCOCK STREET CAMPUS BOX 112
Practice Address - Street 2:GEORGIA COLLEGE
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-445-2136
Practice Address - Fax:478-445-4074
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAAT0013102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer