Individual
MR. JEREMY MARCUS MAINOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3051 WATSON BLVD, WARNER ROBINS, GA 31093-8536
(478) 971-2235
Mailing address
100 ROBINS WEST PKWY, APT. 718, WARNER ROBINS, GA 31088-8121
(478) 550-6725
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
PTA002538
GA
Other
Enumeration date
12/17/2009
Last updated
12/17/2009
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