Individual
JILL MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
540 LAKE CENTER PKWY, SUITE 107, CUMMING, GA 30040-7727
(770) 205-3939
Mailing address
5155 SHADY GROVE RD, CUMMING, GA 30041-4730
(770) 205-3939
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT004825
LICENSE #
GA
Enumeration date
08/30/2006
Last updated
08/09/2007
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