Provider Demographics
NPI:1689740011
Name:ANDERSON, JEANNETTE RENEE (PT)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:RENEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:RENEE
Other - Last Name:BULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3001 MERCER UNIVERSITY DR
Mailing Address - Street 2:DAVIS SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4115
Mailing Address - Country:US
Mailing Address - Phone:678-547-6247
Mailing Address - Fax:678-547-6202
Practice Address - Street 1:3001 MERCER UNIVERSITY DR
Practice Address - Street 2:DAVIS SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4115
Practice Address - Country:US
Practice Address - Phone:678-547-6247
Practice Address - Fax:678-547-6202
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist