Provider Demographics
NPI:1932665353
Name:REEVES, JAYA
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 MAIN ST STE I
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3096
Mailing Address - Country:US
Mailing Address - Phone:678-694-8100
Mailing Address - Fax:678-477-9396
Practice Address - Street 1:913 MAIN ST STE I
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3096
Practice Address - Country:US
Practice Address - Phone:678-694-8100
Practice Address - Fax:678-647-7939
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003477225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant