MEDICARE: JORDAN ABERNATHY-CORNELIUS LCSW

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	1041C0700X	Clinical Social Worker		GA

General Provider Information

NPI Number	:	1396488433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ABERNATHY-CORNELIUS LCSW

Provider Business Mailing Address
First Line	:	11720 AMBERPARK DR STE 160
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2271
Country	:	US
Telephone Number	:	470-695-0024
Fax Number	:

Provider Business Practice Location Address
First Line	:	11720 AMBERPARK DR STE 160
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2271
Country	:	US
Telephone Number	:	470-695-0024
Fax Number	:

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

Provider Enumeration Date	:	04/17/2022
Last Update Date	:	01/18/2023

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