MEDICARE: JCJ ENTERPRISES

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1467842740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JCJ ENTERPRISES

Provider Business Mailing Address
First Line	:	2511 SAND RIDGE CT
Second Line	:
City	:	HEPHZIBAH
State	:	GA
Zip	:	30815-7081
Country	:	US
Telephone Number	:	706-772-5567
Fax Number	:	706-772-5567

Provider Business Practice Location Address
First Line	:	2511 SAND RIDGE CT
Second Line	:
City	:	HEPHZIBAH
State	:	GA
Zip	:	30815-7081
Country	:	US
Telephone Number	:	706-772-5567
Fax Number	:	706-772-5567

Authorized Official
Title or Position	:	EDUCATIONAL CONSULTANT
Name	:	DR. YOLANDA ROCHELLE DAVIS-ALLEN
Credential	:	PH.D
Telephone Number	:	706-772-5567

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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Directions to “JCJ ENTERPRISES ” Practice Location

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