Provider Demographics
NPI:1740220581
Name:EMPERT, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:EMPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-835-3340
Mailing Address - Fax:404-207-1391
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-835-3340
Practice Address - Fax:404-207-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-03-13
Deactivation Date:2007-07-27
Deactivation Code:
Reactivation Date:2008-03-13
Provider Licenses
StateLicense IDTaxonomies
GAOT004246225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004246OtherOT