Provider Demographics
NPI:1891485835
Name:JEWETT, MACY HAMILTON (RBT)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:HAMILTON
Last Name:JEWETT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-3204
Mailing Address - Country:US
Mailing Address - Phone:229-224-7386
Mailing Address - Fax:
Practice Address - Street 1:523 GROVE LN
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-3204
Practice Address - Country:US
Practice Address - Phone:229-224-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-266243156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist