MEDICARE: MS. JENNIFER E. MARKYNA 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0744R	GA
2	1041C0700X	Clinical Social Worker	CSW001635	GA

General Provider Information

NPI Number	:	1538220439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER E. MARKYNA LCSW

Provider Business Mailing Address
First Line	:	2415 PERSIMMON RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904
Country	:	US
Telephone Number	:	706-736-7918
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E HOSPITAL RD
Second Line	:	EAMC- RTF- 12 WEST
City	:	FT. GORDON
State	:	GA
Zip	:	30905-5650
Country	:	US
Telephone Number	:	706-787-8290
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/10/2013

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