Provider Demographics
NPI:1073998639
Name:BORN, JONATHAN PAUL (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:BORN
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 WISTERIA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2689
Mailing Address - Country:US
Mailing Address - Phone:770-982-0102
Mailing Address - Fax:770-982-0130
Practice Address - Street 1:4220 MUNDY MILL PL
Practice Address - Street 2:SUITE 2B
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2573
Practice Address - Country:US
Practice Address - Phone:678-450-9933
Practice Address - Fax:678-450-9966
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2016-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAAT0027252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer