| Advanced Juvenile Enhancement, Llc | |
|
3058 Rolling Rd N Macon GA 31204-1077 | |
| (478) 320-7837 | |
| Not Available |
| Full Name | Advanced Juvenile Enhancement, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3058 Rolling Rd N, Macon, Georgia |
| Authorized Official Name and Position | Angela Solomon (OWNER) |
| Authorized Official Contact | 4783207837 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Juvenile Enhancement, Llc 3058 Rolling Rd N Macon GA 31204-1077 Ph: (478) 320-7837 | Advanced Juvenile Enhancement, Llc 3058 Rolling Rd N Macon GA 31204-1077 Ph: (478) 320-7837 |
| NPI Number | 1477135994 |
|---|---|
| Provider Enumeration Date | 04/23/2021 |
| Last Update Date | 05/21/2023 |
| Certification Date | 05/21/2023 |
| Medicare PECOS PAC ID | 6103282215 |
|---|---|
| Medicare Enrollment ID | O20230516001398 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477135994 | NPI | - | NPPES |
| 003246411A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Angela Solomon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659792083 PECOS PAC ID: 5395153456 Enrollment ID: I20230523000171 |
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