Individual
JACOB CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1220 W WHEELER PKWY, AUGUSTA, GA 30909-6625
(706) 721-8623
Mailing address
332 LUCERNE AVE, NORTH AUGUSTA, SC 29841-3656
(815) 666-7461
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT016751
GA
Other
Enumeration date
08/18/2023
Last updated
08/18/2023
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