Provider Demographics
NPI:1043387145
Name:REYNOLDS-FARR, JAYLYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAYLYNN
Middle Name:
Last Name:REYNOLDS-FARR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 VERANDAH DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909
Mailing Address - Country:US
Mailing Address - Phone:706-736-0221
Mailing Address - Fax:706-736-0231
Practice Address - Street 1:3604 VERANDAH DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-736-0221
Practice Address - Fax:706-736-0231
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000946063CMedicaid
GA340887OtherWELLCARE
GA52991634-001OtherBCBS OF GEORGIA