Active NPI
Jennifer Richards Bazemore, PT
- Physical Therapist
- Marietta, GA
National Provider Identifier
1659676104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT006147
- Practice address
- 3139 Milford Chase SW
Marietta, GA 30008-5786 - Phone
- (404) 788-3419
- Fax
- (770) 521-9210
- NPI assigned
- Jan 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT006147 | GA | Primary |
Addresses
Primary practice location
3139 Milford Chase SW
Marietta, GA 30008-5786
Mailing address
3139 Milford Chase SW
Marietta, GA 30008-5786
Phone (404) 788-3419
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT006147 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294876800000",
"number": "1659676104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3139 MILFORD CHASE SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300085786",
"telephone_number": "404-788-3419",
"fax_number": "770-521-9210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3139 MILFORD CHASE SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300085786",
"telephone_number": "404-788-3419",
"fax_number": "770-521-9210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAZEMORE",
"first_name": "JENNIFER",
"middle_name": "RICHARDS",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-13",
"last_updated": "2011-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT006147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.