Provider Demographics
NPI:1114329455
Name:WHITTINGTON, JONATHAN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 FAIROAKS CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1206
Mailing Address - Country:US
Mailing Address - Phone:404-247-3244
Mailing Address - Fax:
Practice Address - Street 1:5788 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4904
Practice Address - Country:US
Practice Address - Phone:404-935-9110
Practice Address - Fax:678-530-1042
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0027822255A2300X
FLAL42162255A2300X
246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant