Provider Demographics
NPI:1043389612
Name:NABORS, JOEL (PT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:NABORS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PEACHTREE PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9783
Mailing Address - Country:US
Mailing Address - Phone:678-455-5600
Mailing Address - Fax:678-455-4554
Practice Address - Street 1:610 PEACHTREE PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9783
Practice Address - Country:US
Practice Address - Phone:678-455-5600
Practice Address - Fax:678-455-4554
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008749OtherSTATE LISC NUMBER