Individual
JASON VANAUKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1498 HUDSON BRIDGE RD, STOCKBRIDGE, GA 30281-5018
(678) 289-0525
(678) 289-0529
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3226
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
GA006800
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GA006800
STATE LISC NUMBER
GA
Enumeration date
11/03/2006
Last updated
07/18/2012
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