MEDICARE: MRS. BIANCA HEARD-JEMISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-21-51545	GA

General Provider Information

NPI Number	:	1326692377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BIANCA HEARD-JEMISON

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6361 TALOKAS LN STE C140-158
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-5642
Country	:	US
Telephone Number	:	706-223-4590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	09/26/2022

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