Provider Demographics
NPI:1760406078
Name:MANNERS, JILL ANN (LAT, ATC, PT, COMT)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:MANNERS
Suffix:
Gender:F
Credentials:LAT, ATC, PT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RIVER ROAD 367 RAMSEY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1964
Mailing Address - Country:US
Mailing Address - Phone:706-542-4427
Mailing Address - Fax:
Practice Address - Street 1:330 RIVER ROAD 367 RAMSEY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1964
Practice Address - Country:US
Practice Address - Phone:706-542-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12499225100000X
GAPT013778225100000X
NC10192255A2300X
GAAT0016162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist