MEDICARE: J T COMMUNITY CENTER

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	343900000X	Non-emergency Medical Transport (VAN)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1467601831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J T COMMUNITY CENTER

Provider Business Mailing Address
First Line	:	1069 WASHINGTON ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-1609
Country	:	US
Telephone Number	:	404-622-7343
Fax Number	:	404-622-7343

Provider Business Practice Location Address
First Line	:	1069 WASHINGTON ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-1609
Country	:	US
Telephone Number	:	404-622-7343
Fax Number	:	404-622-7343

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. ANNIE MURRAY
Credential	:
Telephone Number	:	404-622-7343

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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