Provider Demographics
NPI:1790951168
Name:RISTY, JANECE A (ATC)
Entity Type:Individual
Prefix:MS
First Name:JANECE
Middle Name:A
Last Name:RISTY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BROOKSTONE CRST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3852
Mailing Address - Country:US
Mailing Address - Phone:770-755-8768
Mailing Address - Fax:
Practice Address - Street 1:85 BROOKSTONE CRST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3852
Practice Address - Country:US
Practice Address - Phone:770-755-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0024192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT002419OtherPROFESSIONAL LICENSING STATE OF GEORGIA