Provider Demographics
NPI:1114609559
Name:JAIN, JYOTI
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 LAWRENCEVILLE SUWANEE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8603
Mailing Address - Country:US
Mailing Address - Phone:770-574-4141
Mailing Address - Fax:
Practice Address - Street 1:3890 LAWRENCEVILLE SUWANEE RD STE 6
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8603
Practice Address - Country:US
Practice Address - Phone:770-574-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA005105225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant