Provider Demographics
NPI:1487108114
Name:METCALF, JESSICA HEADRICK (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HEADRICK
Last Name:METCALF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 GREEN RD STE N
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-6999
Mailing Address - Country:US
Mailing Address - Phone:706-695-1623
Mailing Address - Fax:706-695-9699
Practice Address - Street 1:1422 GREEN RD STE N
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-6999
Practice Address - Country:US
Practice Address - Phone:706-695-1623
Practice Address - Fax:706-695-9699
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT012513OtherPT LICENSE