Individual
DR. JACOB IRWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4343 SHALLOWFORD RD STE 630, MARIETTA, GA 30062-5080
(770) 449-5152
(866) 821-7683
Mailing address
4343 SHALLOWFORD RD STE 630, MARIETTA, GA 30062-5080
(770) 449-5152
(866) 821-7683
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
GA07576
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GA07576
STATE LISC NUMBER
GA
Enumeration date
11/07/2006
Last updated
04/21/2021
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