Provider Demographics
NPI:1043318660
Name:BROCK, JAMIE T (CRT)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:T
Last Name:BROCK
Suffix:
Gender:M
Credentials:CRT
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Mailing Address - Street 1:1288 S POPLAR SPRINGS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2289
Mailing Address - Country:US
Mailing Address - Phone:478-984-5533
Mailing Address - Fax:478-277-2714
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified