Audrey D. Jernigan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT001243 Issued in GA

Practice address

301 Pineview Dr.
Waycross, GA 31501

Phone

(912) 285-2361

Fax

(912) 285-0571

NPI assigned

Mar 14, 2007

Last updated

Apr 3, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Audrey D. Jernigan Professional name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sports Medicine and Rehab Therapy, LLCGroup PAC ID 1658415054, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sports Medicine and Rehab Therapy, LLC

  dba SMaRT Physical Therapy

  • Physical Medicine & Rehabilitation Physician
  • Waycross, GA
  • NPI 1396079224
  Medicare reassignment Care Compare group NPD
• Pineview Physical Therapy

  • Physical Therapy Clinic/Center
  • Waycross, GA
  • NPI 1215196258
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364947200000",
    "number": "1245363688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 PINEVIEW DR",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015229",
            "telephone_number": "912-285-2361",
            "fax_number": "912-285-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 PINEVIEW DR.",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "31501",
            "telephone_number": "912-285-2361",
            "fax_number": "912-285-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERNIGAN",
        "first_name": "AUDREY",
        "middle_name": "D.",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2013-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT001243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "JERNIGAN",
            "middle_name": "D.",
            "prefix": "MRS.",
            "credential": "P.T.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• James S. Blasko, M.D. P.C.
• Jacqueline F James, RN
• Jane Blalock
• Jebediah S. Christy DDS - Waycross PLLC (Aspen Dental)
• Ashley Brooke Jenkins
• Asit K Jha, MD
• John W Akridge MD PC
• Dasha Renee Johns, LPN
• Amber Johnson, CCC-SLP
• Joletha Williams

• Physical Therapist in Waycross, GA
• Providers in Waycross, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.