Provider Demographics
NPI:1407909211
Name:FOULKES, JENNIE (PT)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:FOULKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8622
Mailing Address - Country:US
Mailing Address - Phone:478-757-1338
Mailing Address - Fax:478-757-8225
Practice Address - Street 1:7440 THOMASTON RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-5160
Practice Address - Country:US
Practice Address - Phone:478-757-1338
Practice Address - Fax:478-757-8225
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist