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Individual

JENNIFER BRACKETT LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T., A.T.,C.

Contact information

Practice address
12 DAWSON MARKET WAY STE 320, DAWSONVILLE, GA 30534-7296
(470) 759-2415
(706) 441-3321
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT005634
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
52183607001
BCBS AUSTELL LOCATION
GA
01
52183607002
BCBS MARIETTA LOCATION
GA
01
52183607003
BCBS WOODSTOCK LOCATION
GA
01
52183607004
BCBS DOUGLASVILLE LOCATIO
GA
Enumeration date
07/03/2006
Last updated
02/15/2024
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