Provider Demographics
NPI:1033665302
Name:MANN, JESSICA HAWKES (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HAWKES
Last Name:MANN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:HAWKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1755 HIGHWAY 34 E
Mailing Address - Street 2:STE 1300
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3186
Mailing Address - Country:US
Mailing Address - Phone:770-254-7850
Mailing Address - Fax:
Practice Address - Street 1:1111 LOWER FAYETTEVILLE RD
Practice Address - Street 2:STE 2000
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6506
Practice Address - Country:US
Practice Address - Phone:770-251-7284
Practice Address - Fax:770-251-7295
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist