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NPI Code Detail

MEDICARE: JACKIE COATS LSW

MEDICARE: JACKIE COATS LSW
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
11041C0700XClinical Social WorkerW5795MS
2104100000XSocial WorkerW5795MS

General Provider Information

NPI Number : 1598288482
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE COATS LSW
Provider Business Mailing Address
First Line : PO BOX 18679
Second Line :
City : HATTIESBURG
State : MS
Zip : 39404-8679
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1721 W 10TH ST
Second Line :
City : LAUREL
State : MS
Zip : 39440-2540
Country : US
Telephone Number : 601-425-9322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2017
Last Update Date : 07/21/2017

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Directions to “ JACKIE COATS LSW” Practice Location

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