Provider Demographics
NPI:1245242460
Name:MULLER, JAMIE LYNN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN
Last Name:MULLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:GRACIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2015 LAKE PARK DR SE APT G
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7615
Mailing Address - Country:US
Mailing Address - Phone:770-431-4715
Mailing Address - Fax:
Practice Address - Street 1:3286 BUCKEYE RD STE 102
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4228
Practice Address - Country:US
Practice Address - Phone:770-455-4600
Practice Address - Fax:770-455-7799
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer