Roots Seeds And Branches | |
209a Swanton Way Ste 202 Decatur GA 30030-3271 | |
(404) 698-5553 | |
Not Available |
Full Name | Roots Seeds And Branches |
---|---|
Speciality | Social Worker |
Location | 209a Swanton Way Ste 202, Decatur, Georgia |
Authorized Official Name and Position | Julius Jessup Peterson (OWNER) |
Authorized Official Contact | 4046985553 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Roots Seeds And Branches 209a Swanton Way Ste 202 Decatur GA 30030-3271 Ph: (404) 698-5553 | Roots Seeds And Branches 209a Swanton Way Ste 202 Decatur GA 30030-3271 Ph: (404) 698-5553 |
NPI Number | 1508353210 |
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Provider Enumeration Date | 04/18/2018 |
Last Update Date | 04/18/2018 |
Medicare PECOS PAC ID | 7416330899 |
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Medicare Enrollment ID | O20220817003056 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508353210 | NPI | - | NPPES |
003181948C | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | CSW005018 (Georgia) | Primary |
Provider Name | Julius Lashame Jessup Peterson |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1932330149 PECOS PAC ID: 3870976251 Enrollment ID: I20220818002976 |
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