Provider Demographics
NPI:1669148920
Name:RAWLS, JACQUELINE TONYA (RRT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:TONYA
Last Name:RAWLS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 ELIAS STA
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-4173
Mailing Address - Country:US
Mailing Address - Phone:229-364-3054
Mailing Address - Fax:
Practice Address - Street 1:1218 ELIAS STA
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-4173
Practice Address - Country:US
Practice Address - Phone:229-364-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8505227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified