Provider Demographics
NPI:1396783643
Name:HUGHES, JEANNIE LYNN (PT)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:LYNN
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HERRON ST
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3126
Mailing Address - Country:US
Mailing Address - Phone:706-861-7471
Mailing Address - Fax:706-861-7472
Practice Address - Street 1:118 HERRON ST
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3126
Practice Address - Country:US
Practice Address - Phone:706-861-7471
Practice Address - Fax:706-861-7472
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3156797OtherBCBST - GROUP NUMBER
TN446652Medicare ID - Type UnspecifiedGROUP NUMBER