Individual
JESSICA HICKINBOTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, MPT
Contact information
Practice address
1163 JOHNSON FERRY RD, MARIETTA, GA 30068-2764
(404) 276-1028
Mailing address
PO BOX 98062, ATLANTA, GA 30359-1762
(404) 276-1028
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009212
GA
Other
Enumeration date
09/30/2014
Last updated
03/05/2021
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