Provider Demographics
NPI:1710911631
Name:PRAHL, JESSI M (ATC/L, OTC)
Entity Type:Individual
Prefix:MS
First Name:JESSI
Middle Name:M
Last Name:PRAHL
Suffix:
Gender:F
Credentials:ATC/L, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 ROCKLAND DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2239
Mailing Address - Country:US
Mailing Address - Phone:404-406-9446
Mailing Address - Fax:
Practice Address - Street 1:1791 ROCKLAND DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2239
Practice Address - Country:US
Practice Address - Phone:404-406-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT001300246Z00000X
GA07-0825246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other