Provider Demographics
NPI:1073637161
Name:FRANCIS, JESSICA MAXINE (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAXINE
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MAXINE
Other - Last Name:PAIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:401 BLOOMBRIDGE WAY NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3486
Mailing Address - Country:US
Mailing Address - Phone:770-499-9918
Mailing Address - Fax:
Practice Address - Street 1:300 TOWER RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9404
Practice Address - Country:US
Practice Address - Phone:770-499-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2210225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant