Provider Demographics
NPI:1750468567
Name:BUTIKOFER, JAMIE LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:LEE
Last Name:BUTIKOFER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535
Mailing Address - Country:US
Mailing Address - Phone:706-778-7161
Mailing Address - Fax:706-776-3020
Practice Address - Street 1:171 RAIDER CIR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:GA
Practice Address - Zip Code:30563-3065
Practice Address - Country:US
Practice Address - Phone:706-778-7161
Practice Address - Fax:706-776-3020
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0003232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer