Provider Demographics
NPI:1487685871
Name:GAMMON, JANET (PT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:GAMMON
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:PO BOX 242278
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2278
Mailing Address - Country:US
Mailing Address - Phone:678-721-9922
Mailing Address - Fax:678-721-7799
Practice Address - Street 1:650 HENDERSON DR STE 103
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3700
Practice Address - Country:US
Practice Address - Phone:678-721-9922
Practice Address - Fax:678-721-7799
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCZCMedicare PIN