Provider Demographics
NPI:1841238847
Name:ARKFELD, JEREMY J (PT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:J
Last Name:ARKFELD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 LANIER ISLANDS PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4591 WINDER HWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3610
Practice Address - Country:US
Practice Address - Phone:770-967-1466
Practice Address - Fax:770-967-8953
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA580699952CMedicaid
GA65BBCZMMedicare ID - Type Unspecified
GA580699952CMedicaid