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1760 Lakes Pkwy Unit 4416 Lawrenceville GA 30043-6194 | |
| (678) 805-7181 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1760 Lakes Pkwy Unit 4416, Lawrenceville, Georgia |
| Authorized Official Name and Position | Raymond Edwin Jeanes (OWNER) |
| Authorized Official Contact | 6788057181 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1760 Lakes Pkwy Unit 4416 Lawrenceville GA 30043-6194 Ph: (678) 805-7181 | 1760 Lakes Pkwy Unit 4416 Lawrenceville GA 30043-6194 Ph: (678) 805-7181 |
| NPI Number | 1780348458 |
|---|---|
| Provider Enumeration Date | 10/28/2021 |
| Last Update Date | 02/28/2022 |
| Certification Date | 02/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780348458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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