MEDICARE: JANICE TAWANDA PERRY LMSW

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	104100000X	Social Worker	MSW001946	GA

General Provider Information

NPI Number	:	1467521435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE TAWANDA PERRY LMSW

Provider Business Mailing Address
First Line	:	157 TYLER RDG
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30238-5887
Country	:	US
Telephone Number	:	770-210-6889
Fax Number	:	770-210-9293

Provider Business Practice Location Address
First Line	:	157 TYLER RDG
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30238-5887
Country	:	US
Telephone Number	:	770-210-6889
Fax Number	:	770-210-9293

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/09/2007

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