Provider Demographics
NPI:1093894214
Name:MILLIGAN, JENNA CAUDILL (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:CAUDILL
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:CAUDILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:117 HARMONY XING
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9549
Mailing Address - Country:US
Mailing Address - Phone:706-454-1811
Mailing Address - Fax:706-454-1812
Practice Address - Street 1:117 HARMONY XING
Practice Address - Street 2:SUITE 4
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9549
Practice Address - Country:US
Practice Address - Phone:706-454-1811
Practice Address - Fax:706-454-1812
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008643OtherSTATE LISC NUMBER