Individual
LAMONT JOSEPH JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3888 LAVISTA RD, TUCKER, GA 30084-5142
(770) 938-5740
Mailing address
3888 LAVISTA RD, TUCKER, GA 30084-5142
(770) 938-5740
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002207
GA
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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