Jeremy Marcus Mainor, PTA

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

PTA002538 Issued in GA

Practice address

3051 Watson Blvd
Warner Robins, GA 31093-8536

Phone

(478) 971-2235

NPI assigned

Dec 17, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261008000000",
    "number": "1609105808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ROBINS WEST PKWY",
            "address_2": "APT. 718",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310888121",
            "telephone_number": "478-550-6725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3051 WATSON BLVD",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310938536",
            "telephone_number": "478-971-2235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAINOR",
        "first_name": "JEREMY",
        "middle_name": "MARCUS",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-17",
        "last_updated": "2009-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "GA",
            "license": "PTA002538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Health Worker in Warner Robins, GA
• Providers in Warner Robins, GA by specialty
• Community Health Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.