Provider Demographics
NPI:1336724350
Name:EUBANKS, JANE M
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MCWHORTER
Other - Last Name:EUBANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:677 RED SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6420
Mailing Address - Country:US
Mailing Address - Phone:404-375-9813
Mailing Address - Fax:770-218-2688
Practice Address - Street 1:7421 DOUGLAS BLVD STE A
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1564
Practice Address - Country:US
Practice Address - Phone:678-483-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist