Provider Demographics
NPI:1205917739
Name:TWYMAN, JILL SUZANNE (DPT)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:SUZANNE
Last Name:TWYMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5077 JIMMY LEE SMITH PKWY.
Mailing Address - Street 2:SUITE 119
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141
Mailing Address - Country:US
Mailing Address - Phone:770-222-6621
Mailing Address - Fax:770-222-8845
Practice Address - Street 1:5077 JIMMY LEE SMITH PKWY.
Practice Address - Street 2:SUITE 119
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:770-222-6621
Practice Address - Fax:770-222-8845
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist