Individual
JON MICHAEL PRESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.P.T.
Contact information
Practice address
1810 PEACHTREE INDUSTRIAL BLVD, SUITE 130, DULUTH, GA 30097-8180
(770) 232-7100
(770) 232-7198
Mailing address
2557 COLLINS PORT CV, SUWANEE, GA 30024-2787
(770) 232-7100
(770) 232-7198
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT006667
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52068657-004
BCBSGA PROVIDER NUMBER
GA
01
—
7480721
AETNA PPO POS PIN
GA
01
—
9406564
PHCS PIN
GA
Enumeration date
01/03/2007
Last updated
07/09/2007
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