Individual
JILL PAINTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2315 CENTRAL AVE STE C, AUGUSTA, GA 30904-6246
(706) 364-6172
Mailing address
4133 KEMPER CT, EVANS, GA 30809-4068
(706) 364-6172
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
004411
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004411
GEORGIA LICENSE
GA
Enumeration date
03/08/2007
Last updated
08/16/2007
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